Healthcare Provider Details

I. General information

NPI: 1013220649
Provider Name (Legal Business Name): VIGIE AMBAY STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2010
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 HIGHWAY 90
MARIANNA FL
32446-6802
US

IV. Provider business mailing address

2829 HIGHWAY 69
GRAND RIDGE FL
32442-4255
US

V. Phone/Fax

Practice location:
  • Phone: 850-718-5620
  • Fax:
Mailing address:
  • Phone: 850-209-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: