Provider Demographics
NPI:1043936677
Name:CABEZA, STEPHANIE DAWN (LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:CABEZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11142 MAUSEL ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8097
Mailing Address - Country:US
Mailing Address - Phone:214-298-4778
Mailing Address - Fax:
Practice Address - Street 1:10421 VFW RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8075
Practice Address - Country:US
Practice Address - Phone:907-694-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK194093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist