Healthcare Provider Details

I. General information

NPI: 1972550663
Provider Name (Legal Business Name): STEPHANIE ALSUP P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 N BEDELL AVE
DEL RIO TX
78840-7818
US

IV. Provider business mailing address

1308 N BEDELL AVE
DEL RIO TX
78840
US

V. Phone/Fax

Practice location:
  • Phone: 830-774-1556
  • Fax: 830-774-6150
Mailing address:
  • Phone: 830-774-1556
  • Fax: 830-774-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1078137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: