Provider Demographics
NPI:1306263348
Name:GREENWOOD, STEPHANIE NICOLE (CMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:511 WASHINGTON ST
Mailing Address - Street 2:APT 4
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-5195
Mailing Address - Country:US
Mailing Address - Phone:651-413-0950
Mailing Address - Fax:
Practice Address - Street 1:328 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist