Basic Information
| Provider Information | |||||||||
| NPI: | 1437550464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSE | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 HOLLY CIR | ||||||||
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| City: | SPENCERPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145599602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857493596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5001 STATESMAN DR | ||||||||
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| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772825613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2014 | ||||||||
| LastUpdateDate: | 09/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15175 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.