Individual
STACEY MARIE BANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
7540 N 19TH AVE STE 200, PHOENIX, AZ 85021-7967
(888) 873-4221
Mailing address
96 TIMBER DR, DURANGO, CO 81303-7562
(505) 379-0777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0014580
CO
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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