MEDICARE: MRS. STEPHANIE BROOKE RESSLER MPT, PCS

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	2251P0200X	Pediatric Physical Therapist	1150013	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902805401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE BROOKE RESSLER MPT, PCS

Provider Business Mailing Address
First Line	:	177 HOLT ST
Second Line	:
City	:	OVERTON
State	:	TX
Zip	:	75684-1202
Country	:	US
Telephone Number	:	936-622-0098
Fax Number	:	877-798-4959

Provider Business Practice Location Address
First Line	:	3310 S BROADWAY AVE STE 100I
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-7818
Country	:	US
Telephone Number	:	903-781-1832
Fax Number	:	877-798-4959

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	03/16/2026

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