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1063076131
STACEY MARIE BANES
PHOENIX, AZ
NPI
1063076131
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CO PTA.0014580)
Enumeration Date
2019-04-24
Last Update Date
2019-04-24
Business Address
STACEY MARIE BANES PTA
7540 N 19TH AVE STE 200
PHOENIX, AZ 85021-7967
Phone number: 888-873-4221
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Mailing Address
STACEY MARIE BANES PTA
96 TIMBER DR
DURANGO, CO 81303-7562
Phone number: 505-379-0777
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