Provider Demographics
NPI:1801934716
Name:SULLANO, STEPHANIE J (PT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:SULLANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:KERWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1201 BROOKS STREET
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4900
Mailing Address - Country:US
Mailing Address - Phone:281-690-4607
Mailing Address - Fax:281-690-4608
Practice Address - Street 1:1201 BROOKS STREET
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4000
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-690-4608
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5300Medicare ID - Type Unspecified