Provider Demographics
NPI:1023870086
Name:DI STEFANO, SARA (LMT, MTI, CEP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DI STEFANO
Suffix:
Gender:F
Credentials:LMT, MTI, CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 LINKLEA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3022
Mailing Address - Country:US
Mailing Address - Phone:718-715-9722
Mailing Address - Fax:
Practice Address - Street 1:16607 BLANCO RD STE 1304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:210-679-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist