Provider Demographics
NPI:1134926470
Name:WESTFALL, STEPHEN WAYNE (ATC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:WESTFALL
Suffix:
Gender:
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-5208
Mailing Address - Country:US
Mailing Address - Phone:585-610-9188
Mailing Address - Fax:
Practice Address - Street 1:3405 CITATION DR
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-5208
Practice Address - Country:US
Practice Address - Phone:585-610-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL33652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer