Provider Demographics
NPI:1336349414
Name:THOMAS, STEPHANIE A (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N MISSION PARK BLVD APT 2093
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3998
Mailing Address - Country:US
Mailing Address - Phone:860-884-0581
Mailing Address - Fax:
Practice Address - Street 1:650 S ATHLETES PL
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-8519
Practice Address - Country:US
Practice Address - Phone:480-449-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer