Provider Demographics
NPI:1013408079
Name:SMITH, STEPHANIE M (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STEPHANIE SMITH LMT
Mailing Address - Street 1:17504 SILENT HARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2244
Mailing Address - Country:US
Mailing Address - Phone:512-308-8836
Mailing Address - Fax:
Practice Address - Street 1:3613 WILLIAMS DR STE 1003
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1376
Practice Address - Country:US
Practice Address - Phone:512-308-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist