Provider Demographics
NPI:1649684986
Name:CARSTON, STEPHANIE (LMP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CARSTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 S MASON AVE
Mailing Address - Street 2:APT H 304
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3202 S MASON AVE
Practice Address - Street 2:APT H 304
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2278
Practice Address - Country:US
Practice Address - Phone:253-442-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60416530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist