Provider Demographics
NPI:1972340172
Name:DUNLAP, STEPHANIE ELEENE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELEENE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 100 W
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2902
Mailing Address - Country:US
Mailing Address - Phone:435-650-4592
Mailing Address - Fax:
Practice Address - Street 1:90 W 100 N
Practice Address - Street 2:SUITE #4
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2463
Practice Address - Country:US
Practice Address - Phone:435-650-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6590916-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist