Provider Demographics
NPI:1902805401
Name:RESSLER, STEPHANIE BROOKE (MPT, PCS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BROOKE
Last Name:RESSLER
Suffix:
Gender:F
Credentials:MPT, PCS
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:BROOKE
Other - Last Name:BULLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, PCS
Mailing Address - Street 1:4635 NE STALLINGS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1667
Mailing Address - Country:US
Mailing Address - Phone:936-622-0098
Mailing Address - Fax:888-552-2070
Practice Address - Street 1:4635 NE STALLINGS DR STE 101
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1667
Practice Address - Country:US
Practice Address - Phone:936-622-0098
Practice Address - Fax:888-552-2070
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11500132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169552002Medicaid
TX8C2132Medicare PIN