Provider Demographics
NPI:1194338699
Name:FANT, STEPHANIE MICHELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:FANT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 ALLISON BONNETT MEMORIAL DR STE 144
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2394
Mailing Address - Country:US
Mailing Address - Phone:205-744-9444
Mailing Address - Fax:205-744-9477
Practice Address - Street 1:3014 ALLISON BONNETT MEMORIAL DR STE 144
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2394
Practice Address - Country:US
Practice Address - Phone:205-744-9444
Practice Address - Fax:205-744-9477
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist