Individual
IVY JO STATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
4206 N ROXBORO ST STE 130, DURHAM, NC 27704-1868
(919) 729-5048
(919) 729-5038
Mailing address
4206 N ROXBORO ST STE 130, DURHAM, NC 27704-1868
(919) 729-5048
(919) 729-5038
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3870
NC
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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