=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710427935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE STINE PT,DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2017
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3508 FAR WEST BLVD SUITE 240
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-3080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-832-9411
-----------------------------------------------------
Fax | 512-832-9401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11700 HARDWOOD TRL
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78750-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-866-4332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 1290121
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------