Provider Demographics
NPI:1366784316
Name:CONTI, STEPHEN MICHAEL (LMT, BA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:CONTI
Suffix:
Gender:M
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 GOVERNOR WARFIELD PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3340
Mailing Address - Country:US
Mailing Address - Phone:443-718-0611
Mailing Address - Fax:
Practice Address - Street 1:10025 GOVERNOR WARFIELD PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3340
Practice Address - Country:US
Practice Address - Phone:443-718-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist