Provider Demographics
NPI:1033291745
Name:PRYOR, STEPHANIE E (MPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1; SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:711 E MISSOURI AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2841
Practice Address - Country:US
Practice Address - Phone:602-433-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005026627225100000X
AZ11996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist