Provider Demographics
NPI:1093771313
Name:LENNON, STEPHANIE ANN (ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN
Last Name:LENNON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 BRERETON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2908
Mailing Address - Country:US
Mailing Address - Phone:407-240-8330
Mailing Address - Fax:407-850-5152
Practice Address - Street 1:6000 WINEGARD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4879
Practice Address - Country:US
Practice Address - Phone:407-852-3200
Practice Address - Fax:407-850-5152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL1772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer