Provider Demographics
NPI:1912603754
Name:ALVARENGA, STEPHANIE MARIE (LMT, RTT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:ALVARENGA
Suffix:
Gender:F
Credentials:LMT, RTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 RICE MILL AVE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1898
Mailing Address - Country:US
Mailing Address - Phone:346-610-3474
Mailing Address - Fax:
Practice Address - Street 1:810 HIGHWAY 6 S STE 201E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4022
Practice Address - Country:US
Practice Address - Phone:713-322-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1643097171400000X
TXMT130964225700000X
TXCERTIFICATE171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT130964OtherLICENSED MASSAGE THERAPISTS