Healthcare Provider Details

I. General information

NPI: 1316199664
Provider Name (Legal Business Name): STEPHANIE LOUISE SANDERS MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LOUISE HINTZEL MS, PT

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 E RAILROAD AVE
GIDDINGS TX
78942
US

IV. Provider business mailing address

PO BOX 1615
GIDDINGS TX
78942
US

V. Phone/Fax

Practice location:
  • Phone: 979-542-7300
  • Fax: 979-542-7373
Mailing address:
  • Phone: 979-542-7300
  • Fax: 979-542-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1173110
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: