Provider Demographics
NPI:1871987081
Name:BOOKER, STEPHANIE LEIGH (LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:BOOKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ROBINS WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1129
Mailing Address - Country:US
Mailing Address - Phone:270-893-8706
Mailing Address - Fax:888-704-8506
Practice Address - Street 1:105 ROBINS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1129
Practice Address - Country:US
Practice Address - Phone:270-893-8706
Practice Address - Fax:888-704-8506
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBMTMTH00217419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist