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General NPI Number Information
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NPI Number | 1407516446
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Entity Type | Organization
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Legal Business Name | STABLE STRIDES FARM
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | STABLE STRIDES FARM 4400 WITHERS AVE
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City | FLOWER MOUND
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State | TX
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Zip | 75028
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Country | US
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Telephone | 940-595-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 902 E FRENCHTOWN RD
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City | ARGYLE
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State | TX
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Zip | 76226
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Country | US
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Telephone | 940-595-3600
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHYSICAL THERAPIST
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Name | SUZANNE LEE SESSUMS
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Credential | PT, DPT
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Telephone | 817-368-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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