Basic Information
| Provider Information | |||||||||
| NPI: | 1548635592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVORE | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PTA | ||||||||
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| OtherLastName: | DEVORE | ||||||||
| OtherFirstName: | TESS | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9220 KIRBY DR | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133839700 | ||||||||
| FaxNumber: | 7133839795 | ||||||||
| Practice Location | |||||||||
| Address1: | 9220 KIRBY DR | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133839700 | ||||||||
| FaxNumber: | 7133839795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2015 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 2043750 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.