Provider Demographics
NPI:1962934208
Name:MOONEY, STEPHANIE (MS, ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 BLACKWATER WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1972
Mailing Address - Country:US
Mailing Address - Phone:443-617-0150
Mailing Address - Fax:
Practice Address - Street 1:1 AVENUE OF THE ARTS
Practice Address - Street 2:RATCLIFFE HALL
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3072
Practice Address - Country:US
Practice Address - Phone:757-594-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260024752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer