Provider Demographics
NPI:1437441599
Name:SMITH, STEPHANIE LYNN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 W MARCH LN
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5263
Mailing Address - Country:US
Mailing Address - Phone:209-888-8602
Mailing Address - Fax:209-888-8603
Practice Address - Street 1:2333 W MARCH LN
Practice Address - Street 2:SUITE B-4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5263
Practice Address - Country:US
Practice Address - Phone:209-888-8602
Practice Address - Fax:209-888-8603
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist