Individual
STACEY MARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
340 S LEMON AVE # 6219, WALNUT, CA 91789-2706
(541) 921-1121
Mailing address
340 S LEMON AVE # 6219, WALNUT, CA 91789-2706
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
08039
OR
225200000X
Physical Therapy Assistant
Primary
PTA 25595
FL
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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