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General NPI Number Information
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NPI Number | 1861404436
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Entity Type | Individual
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Provider Name | STACY FLYNN
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 713-794-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 12114 BROWNING DR
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City | MONTGOMERY
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State | TX
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Zip | 77356-5437
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Country | US
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Telephone | 936-582-2699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1165290
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License Number State | TX
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