Provider Demographics
NPI:1578570602
Name:FORSBERG, STEPHANIE S (LMP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 HINKLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8729
Mailing Address - Country:US
Mailing Address - Phone:360-286-7157
Mailing Address - Fax:360-871-1220
Practice Address - Street 1:4740 RAMSEY RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-286-7157
Practice Address - Fax:360-871-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist