Provider Demographics
NPI:1558668855
Name:REID, STEPHANIE EVELYN (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:EVELYN
Last Name:REID
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5229
Mailing Address - Country:US
Mailing Address - Phone:443-904-7304
Mailing Address - Fax:877-374-2421
Practice Address - Street 1:213 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5229
Practice Address - Country:US
Practice Address - Phone:443-904-7304
Practice Address - Fax:877-374-2421
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist