Provider Demographics
NPI:1295746899
Name:BUSSEY, STEPHANIE D (PT MPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MPT
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294
Mailing Address - Country:US
Mailing Address - Phone:210-572-6313
Mailing Address - Fax:210-545-9369
Practice Address - Street 1:19260 STONE OAK PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-545-9355
Practice Address - Fax:210-545-9367
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86494TOtherBCBS
TX83789EMedicare ID - Type Unspecified
P47953Medicare UPIN