Provider Demographics
NPI:1942771340
Name:STAVROS, KERRI SPURLOCK (PT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:SPURLOCK
Last Name:STAVROS
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 1:11016 GLEN ECHO CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3731
Mailing Address - Country:US
Mailing Address - Phone:214-394-8846
Mailing Address - Fax:
Practice Address - Street 1:3450 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6803
Practice Address - Country:US
Practice Address - Phone:972-532-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10872602251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics