Provider Demographics
NPI:1134716020
Name:SILVA, STEPHANIE SOLEAU (LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SOLEAU
Last Name:SILVA
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 1:43 DEXTER POND RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-4000
Mailing Address - Country:US
Mailing Address - Phone:207-446-8522
Mailing Address - Fax:
Practice Address - Street 1:1223 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-3810
Practice Address - Country:US
Practice Address - Phone:207-446-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty