Provider Demographics
NPI:1528307469
Name:WORREL, STEPHEN A JR (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:WORREL
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 HARDY ST STE 20
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1539
Mailing Address - Country:US
Mailing Address - Phone:601-297-1740
Mailing Address - Fax:769-390-7918
Practice Address - Street 1:3906 HARDY ST # 15
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1683
Practice Address - Country:US
Practice Address - Phone:601-297-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ42538AMedicare PIN