Individual
STACIE PERICLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
13801 E BENSON HWY, VAIL, AZ 85641-9074
(520) 879-2052
Mailing address
13801 E BENSON HWY, VAIL, AZ 85641-9074
(520) 879-2052
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2957
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952438368
—
AZ
Enumeration date
07/23/2013
Last updated
07/23/2013
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