| Stomptherapy Llc | |
|
201 Duck Creek Ln Georgetown TX 78633-4114 | |
| (850) 543-7776 | |
| Not Available |
| Full Name | Stomptherapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 201 Duck Creek Ln, Georgetown, Texas |
| Authorized Official Name and Position | Gerald David Nicklen (PRESIDENT STOMPTHERAPY, LLC) |
| Authorized Official Contact | 8505437776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stomptherapy Llc 201 Duck Creek Ln Georgetown TX 78633-4114 Ph: (850) 543-7776 | Stomptherapy Llc 201 Duck Creek Ln Georgetown TX 78633-4114 Ph: (850) 543-7776 |
| NPI Number | 1235585837 |
|---|---|
| Provider Enumeration Date | 05/12/2016 |
| Last Update Date | 05/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235585837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 60420 (Texas) | Primary |
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