Individual
MRS. WANDA ILENE STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
815 SOUTH WALNUT AVE, COOKEVILLE, TN 38501
(931) 646-7216
(931) 528-8151
Mailing address
3122 DEERHAVEN DRIVE S, ALGOOD, TN 38506
(931) 537-2144
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2007
TN
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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