Provider Demographics
NPI:1376758615
Name:STEPHENS, SHARON A (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:STEPHENS
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 1:499 E. CENTRAL PARKWAY
Mailing Address - Street 2:#115
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-260-0646
Mailing Address - Fax:407-260-6914
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:#115
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-260-0646
Practice Address - Fax:407-260-6914
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 48837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist