Provider Demographics
NPI:1811547649
Name:STUBBLEFIELD, THERESIA HANNELORE
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:HANNELORE
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2928
Mailing Address - Country:US
Mailing Address - Phone:302-943-5503
Mailing Address - Fax:
Practice Address - Street 1:755 WALKER RD STE B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2724
Practice Address - Country:US
Practice Address - Phone:302-943-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT004403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist