Provider Demographics
NPI:1477884682
Name:JACOBS FRAZIER, STEPHANIE BLEVINS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BLEVINS
Last Name:JACOBS FRAZIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:BLEVINS
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6141 COUNTRY RD 739
Mailing Address - Street 2:
Mailing Address - City:IDER
Mailing Address - State:AL
Mailing Address - Zip Code:35981
Mailing Address - Country:US
Mailing Address - Phone:256-657-5575
Mailing Address - Fax:
Practice Address - Street 1:11749 ALABAMA HIGHWAY 75
Practice Address - Street 2:6141 COUNTY ROAD 739
Practice Address - City:IDER
Practice Address - State:AL
Practice Address - Zip Code:35981
Practice Address - Country:US
Practice Address - Phone:256-657-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist