MEDICARE: STEPHANIE DECKARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1073917514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DECKARD

Provider Business Mailing Address
First Line	:	1607 REEVESTON RD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5642
Country	:	US
Telephone Number	:	817-909-7754
Fax Number	:	765-644-0510

Provider Business Practice Location Address
First Line	:	1607 REEVESTON RD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-5642
Country	:	US
Telephone Number	:	817-909-7754
Fax Number	:	765-644-0510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/13/2014

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Directions to “ STEPHANIE DECKARD ” Practice Location

Language	Start Address	Practice Location

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