Healthcare Provider Details

I. General information

NPI: 1699128678
Provider Name (Legal Business Name): STEPHENS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 11TH ST
HUNTINGTON WV
25701-2210
US

IV. Provider business mailing address

523 11TH ST
HUNTINGTON WV
25701-2210
US

V. Phone/Fax

Practice location:
  • Phone: 304-972-8441
  • Fax:
Mailing address:
  • Phone: 304-972-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number23333487
License Number StateWV

VIII. Authorized Official

Name: SARAH NICOLE STEPHENS
Title or Position: OWNER AND MASSAGE THERAPIST
Credential: LMT
Phone: 304-972-8441