Provider Demographics
NPI:1487385597
Name:SLATER, STACIA (LMT)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:SLATER
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 1:10373 E PAINTED TURTLE LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-8916
Mailing Address - Country:US
Mailing Address - Phone:623-399-2630
Mailing Address - Fax:
Practice Address - Street 1:10373 E PAINTED TURTLE LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-8916
Practice Address - Country:US
Practice Address - Phone:623-399-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25384225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist