Provider Demographics
NPI:1780866160
Name:FORRESTER, STEPHEN C (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:STEPHEN
Middle Name:C
Last Name:FORRESTER
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3707
Mailing Address - Country:US
Mailing Address - Phone:318-441-2211
Mailing Address - Fax:318-441-1111
Practice Address - Street 1:2150 BOYCE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3707
Practice Address - Country:US
Practice Address - Phone:318-441-2211
Practice Address - Fax:318-441-1111
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA#0877171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor