Provider Demographics
NPI:1679170658
Name:STIGERS, STEPHANIE R
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:STIGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-5328
Mailing Address - Country:US
Mailing Address - Phone:214-536-8487
Mailing Address - Fax:
Practice Address - Street 1:3214 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5328
Practice Address - Country:US
Practice Address - Phone:214-536-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist