Provider Demographics
NPI:1699534446
Name:DEAL, STEPHANIE HURST (LPTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HURST
Last Name:DEAL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 INLET VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-7903
Mailing Address - Country:US
Mailing Address - Phone:704-699-9701
Mailing Address - Fax:
Practice Address - Street 1:1102 INLET VIEW DR
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-7903
Practice Address - Country:US
Practice Address - Phone:704-699-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant