Provider Demographics
NPI:1770026353
Name:FLETCHER, STEPHANIE DANA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DANA
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 103 BOX 179
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09603-0002
Mailing Address - Country:US
Mailing Address - Phone:856-364-8796
Mailing Address - Fax:
Practice Address - Street 1:AVIANO AIR BASE
Practice Address - Street 2:AREA F BLDG 1466
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09603
Practice Address - Country:US
Practice Address - Phone:856-364-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0075762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer