Healthcare Provider Details

I. General information

NPI: 1033248455
Provider Name (Legal Business Name): CHRISTY ANGELA STEVENS-DOUGLAS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8747 MARTIN LN
ZOLFO SPRINGS FL
33890-2824
US

IV. Provider business mailing address

8747 MARTIN LN
ZOLFO SPRINGS FL
33890-2824
US

V. Phone/Fax

Practice location:
  • Phone: 863-784-0494
  • Fax:
Mailing address:
  • Phone: 863-784-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA38414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: