Healthcare Provider Details

I. General information

NPI: 1932316460
Provider Name (Legal Business Name): CHRIS ELLIOTT STOLLE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14857 SOUTHWEST FWY SUITE C-303
SUGAR LAND TX
77478-5016
US

IV. Provider business mailing address

PO BOX 609 818 JOHN ALBERT DR.
EAST BERNARD TX
77435-0609
US

V. Phone/Fax

Practice location:
  • Phone: 281-242-8900
  • Fax: 281-242-0355
Mailing address:
  • Phone: 979-335-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2029098
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: