Provider Demographics
NPI:1306803747
Name:WYLIE, STEFANI ANN (PT)
Entity type:Individual
Prefix:MS
First Name:STEFANI
Middle Name:ANN
Last Name:WYLIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 GARLAND RD
Mailing Address - Street 2:STE 1105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3697
Mailing Address - Country:US
Mailing Address - Phone:214-324-5851
Mailing Address - Fax:214-324-5728
Practice Address - Street 1:9219 GARLAND RD
Practice Address - Street 2:STE 1105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3697
Practice Address - Country:US
Practice Address - Phone:214-324-5851
Practice Address - Fax:214-324-5728
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4261OtherBCBS