Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5501011626 | MI |
NPI | 1134324577 |
---|---|
Provider Name | Stephanie Ann Lamphere |
First Address | Traverse City, MI 49684-6863 |
Second Address | Traverse City, MI 49686-3464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2007 |
Last Update Date | 25/07/2011 |