Provider Demographics
NPI:1306019864
Name:FARRER, STEPHANIE DIANE (LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DIANE
Last Name:FARRER
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 1:813 US 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2173
Mailing Address - Country:US
Mailing Address - Phone:863-381-1195
Mailing Address - Fax:863-471-0750
Practice Address - Street 1:813 US 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2173
Practice Address - Country:US
Practice Address - Phone:863-381-1195
Practice Address - Fax:863-471-0750
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist