Provider Demographics
NPI:1962672832
Name:LUNSFORD, STEPHANIE LYNN (PTA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 US-29 NORTH
Mailing Address - Street 2:WESLEY WOODS
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2006 PELHAM RD
Practice Address - Street 2:GREENVILLE PLACE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4005
Practice Address - Country:US
Practice Address - Phone:864-315-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3418225200000X
NCA3950225200000X
GA003698225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant