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General NPI Number Information
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NPI Number | 1780054189
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN STEPHENS LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 550 BRANDON AVE ROOM 331
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903
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Country | US
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Telephone | 815-451-6149
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Fax |
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Provider Business Mailing Address
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Address Line | 607 MEADOW LN
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City | HARVARD
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State | IL
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Zip | 60033-8359
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Country | US
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Telephone | 815-451-6149
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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 | 0126003190
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License Number State | VA
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