Healthcare Provider Details

I. General information

NPI: 1497111652
Provider Name (Legal Business Name): STEPHANIE HOWARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7273 S SIWELL RD
JACKSON MS
39272-9776
US

IV. Provider business mailing address

PO BOX 2153 DEPT 1947
BIRMINGHAM AL
35287-0002
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-8223
  • Fax: 601-372-8125
Mailing address:
  • Phone: 601-372-8223
  • Fax: 601-372-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5756
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: