Provider Demographics
NPI:1003288366
Name:LOHMAN, STEPHANIE (MS LAT ACT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LOHMAN
Suffix:
Gender:F
Credentials:MS LAT ACT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SWANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3946 ICE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1018
Mailing Address - Country:US
Mailing Address - Phone:260-246-9200
Mailing Address - Fax:
Practice Address - Street 1:7616 W CROMWELL RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-9607
Practice Address - Country:US
Practice Address - Phone:260-246-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002958A2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer