MEDICARE: STEPHANIE GAIL MYERS-KIKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2077076	TX

General Provider Information

NPI Number	:	1629532494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE GAIL MYERS-KIKER

Provider Business Mailing Address
First Line	:	14719 FALL CREEK PRESERVE DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WOODLAND PARK DR
Second Line	:
City	:	SHEPHERD
State	:	TX
Zip	:	77371-6497
Country	:	US
Telephone Number	:	936-628-3388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	01/25/2019

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