Provider Demographics
NPI:1124467246
Name:FAVIA, STEVEN C (MAT, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:FAVIA
Suffix:
Gender:M
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 HOLLOW STUMP RUN
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1250
Mailing Address - Country:US
Mailing Address - Phone:941-212-7125
Mailing Address - Fax:
Practice Address - Street 1:4321 HOLLOW STUMP RUN
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1250
Practice Address - Country:US
Practice Address - Phone:941-212-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 30702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer