Healthcare Provider Details

I. General information

NPI: 1962331942
Provider Name (Legal Business Name): STEPHANIE VANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S MOBBERLY AVE
LONGVIEW TX
75602-2934
US

IV. Provider business mailing address

702 E AUREL AVE
LONGVIEW TX
75602-3006
US

V. Phone/Fax

Practice location:
  • Phone: 909-538-1085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2185220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: