=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487735437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE RENEE WEEMS DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9601 INTERSTATE 630 EXIT 7 BAPTIST HEALTH
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-7299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-202-1305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13815 CARRINGTON PLACE DRIVE
-----------------------------------------------------
City | ALEXANDER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72002-7254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-255-0408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT2841
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------