Provider Demographics
NPI:1215321344
Name:MAY, STEPHANIE (BA, LMT, CPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:BA, LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1846
Mailing Address - Country:US
Mailing Address - Phone:415-407-0897
Mailing Address - Fax:
Practice Address - Street 1:15 W MANOR DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1846
Practice Address - Country:US
Practice Address - Phone:415-407-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist