Provider Demographics
NPI:1154118339
Name:MASSEY, STEPHANIE T
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:MASSEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23626 MAGIC MOUNTAIN PKWY APT 501
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1304
Mailing Address - Country:US
Mailing Address - Phone:559-510-0204
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3322
Practice Address - Country:US
Practice Address - Phone:818-774-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner