Provider Demographics
NPI:1609051119
Name:STANKEVICH, KATHERINE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:STANKEVICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 WOODFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8639
Mailing Address - Country:US
Mailing Address - Phone:615-371-8838
Mailing Address - Fax:
Practice Address - Street 1:1524 WOODFIELD CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8639
Practice Address - Country:US
Practice Address - Phone:615-371-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist