Individual
STEPHANIE L BACA
Active
Individual
STEPHANIE L BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3533
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Q0406
—
NM
01
—
1386651412
BILLING NPI
NM
Enumeration date
08/06/2009
Last updated
12/02/2021
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