Provider Demographics
NPI:1790236032
Name:YODER, JAN STEPHANIE (LMT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:STEPHANIE
Last Name:YODER
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 1:3058 GYPSY ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-7422
Mailing Address - Country:US
Mailing Address - Phone:828-550-5165
Mailing Address - Fax:
Practice Address - Street 1:3737 BAHIA VISTA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2422
Practice Address - Country:US
Practice Address - Phone:941-957-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA74131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist