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General NPI Number Information
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NPI Number | 1659992030
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Entity Type | Individual
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Provider Name | STEPHANIE RACHEL TOUBMAN DAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 14 SENTRY HL
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-4123
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Country | US
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Telephone | 949-212-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 133 DERBE CT # 6-133
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City | TERRE HAUTE
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State | IN
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Zip | 47803-9464
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Country | US
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Telephone | 949-212-0051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36003677A
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License Number State | IN
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