Provider Demographics
NPI:1114682499
Name:ADAMS, STEPHANIE DENISE (LMT, LMDC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMT, LMDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14090 METROPOLIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4451
Mailing Address - Country:US
Mailing Address - Phone:239-489-4100
Mailing Address - Fax:239-489-4100
Practice Address - Street 1:14090 METROPOLIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4451
Practice Address - Country:US
Practice Address - Phone:239-489-4100
Practice Address - Fax:239-489-4100
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist