MEDICARE: STEPHANIE PHAM PT, DPT

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	225100000X	Physical Therapist		SC
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538907175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PHAM PT, DPT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 RUFE SNOW DR STE 110
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6021
Country	:	US
Telephone Number	:	817-345-4367
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	01/02/2026

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