1477884682 NPI number — MRS. STEPHANIE BLEVINS JACOBS FRAZIER L.M.T.

Table of content: MRS. STEPHANIE BLEVINS JACOBS FRAZIER L.M.T. (NPI 1477884682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477884682 NPI number — MRS. STEPHANIE BLEVINS JACOBS FRAZIER L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS FRAZIER
Provider First Name:
STEPHANIE
Provider Middle Name:
BLEVINS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
BLEVINS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477884682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6141 COUNTRY RD 739
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-657-5575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11749 ALABAMA HIGHWAY 75
Provider Second Line Business Practice Location Address:
6141 COUNTY ROAD 739
Provider Business Practice Location Address City Name:
IDER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-657-5575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  2278 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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