Provider Demographics
NPI:1841584323
Name:ANDERSEN, STEPHANIE A (LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:ANDERSEN
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 1:1563 EAGLES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6471
Mailing Address - Country:US
Mailing Address - Phone:772-589-1627
Mailing Address - Fax:772-589-7279
Practice Address - Street 1:1360 US 1
Practice Address - Street 2:SUITE 5
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5703
Practice Address - Country:US
Practice Address - Phone:772-589-1627
Practice Address - Fax:772-589-7279
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist