Provider Demographics
NPI:1740228816
Name:CAMP, STEPHANIE LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:CAMP
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10626 APISON PIKE
Mailing Address - Street 2:
Mailing Address - City:APISON
Mailing Address - State:TN
Mailing Address - Zip Code:37302
Mailing Address - Country:US
Mailing Address - Phone:423-236-4391
Mailing Address - Fax:423-236-4392
Practice Address - Street 1:10626 APISON PIKE
Practice Address - Street 2:
Practice Address - City:APISON
Practice Address - State:TN
Practice Address - Zip Code:37302
Practice Address - Country:US
Practice Address - Phone:423-236-4391
Practice Address - Fax:423-236-4392
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6806225100000X
GAPT007854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA703652OtherBCBSGA
GA796468428BMedicaid
GA796468428AMedicaid
GA317366OtherBCBSGA
GA796468428AMedicaid