Provider Demographics
NPI:1770917841
Name:AMBROSE, STEPHANIE HOWARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOWARD
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:10100 KATY FWY STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:832-795-9175
Practice Address - Fax:832-602-2650
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X553Medicare PIN
TX470445Medicare PIN
TX316765YT6UMedicare PIN
TX316765ZS1KMedicare PIN