Provider Demographics
NPI:1285256792
Name:GARNER, STEPHANIE TAYLOR (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAYLOR
Last Name:GARNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 YORBA CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6834
Mailing Address - Country:US
Mailing Address - Phone:619-840-3975
Mailing Address - Fax:
Practice Address - Street 1:1336 YORBA CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6834
Practice Address - Country:US
Practice Address - Phone:619-840-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2000030329OtherBOARD OF CERTIFICATION ATHLETIC TRAINER
CA001089230OtherNATIONAL STRENGTH AND CONDITIONING ASSOCIATION