Provider Demographics
NPI:1740693647
Name:DEWEESE, STEPHANIE J (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1379
Mailing Address - Country:US
Mailing Address - Phone:479-524-8028
Mailing Address - Fax:479-524-6151
Practice Address - Street 1:1675 W JEFFERSON ST
Practice Address - Street 2:STE A
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3057
Practice Address - Country:US
Practice Address - Phone:479-524-8028
Practice Address - Fax:479-524-6151
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist