Provider Demographics
NPI:1659759488
Name:SAUNDERS, STEFAN DAVID (LMP MA60539535)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:DAVID
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:LMP MA60539535
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 JACOBSON CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4177
Mailing Address - Country:US
Mailing Address - Phone:360-556-6393
Mailing Address - Fax:
Practice Address - Street 1:5709 JACOBSON CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-4177
Practice Address - Country:US
Practice Address - Phone:360-556-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60539535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist