Provider Demographics
NPI:1598299653
Name:NERING, STEPHEN (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:NERING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 W STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5115
Mailing Address - Country:US
Mailing Address - Phone:812-269-8894
Mailing Address - Fax:812-884-8332
Practice Address - Street 1:3980 W STATE ROAD 45
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5115
Practice Address - Country:US
Practice Address - Phone:812-269-8894
Practice Address - Fax:812-884-8332
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22007201225700000X
TXMT118537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist