Provider Demographics
NPI:1396179917
Name:KNOEFLER, STEPHEN RANDOLPH (LMP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RANDOLPH
Last Name:KNOEFLER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 36TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8171
Mailing Address - Country:US
Mailing Address - Phone:425-512-8848
Mailing Address - Fax:
Practice Address - Street 1:11310 36TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8171
Practice Address - Country:US
Practice Address - Phone:425-512-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60408367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist