Provider Demographics
NPI:1083858781
Name:VANOVER, STEPHANIE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:VANOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 32ND ST W
Mailing Address - Street 2:SUITE E30
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2700
Mailing Address - Country:US
Mailing Address - Phone:941-224-5009
Mailing Address - Fax:941-753-1482
Practice Address - Street 1:4301 32ND ST W
Practice Address - Street 2:SUITE E30
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2700
Practice Address - Country:US
Practice Address - Phone:941-224-5009
Practice Address - Fax:941-753-1482
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist