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NPI Code Detail

MEDICARE: STEPHANIE RENEE NYBORG PTA

MEDICARE: STEPHANIE RENEE NYBORG PTA
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
1225200000XPhysical Therapy Assistant2058380TX

General Provider Information

NPI Number : 1528271533
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE RENEE NYBORG PTA
Provider Business Mailing Address
First Line : 205 BENTON DR APT 7302
Second Line :
City : ALLEN
State : TX
Zip : 75013-8589
Country : US
Telephone Number : 972-678-0280
Fax Number :
Provider Business Practice Location Address
First Line : 5515 GLEN LAKES DR
Second Line :
City : DALLAS
State : TX
Zip : 75231-4309
Country : US
Telephone Number : 214-361-8923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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