Individual
STACEY WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2950 LAFRANIER RD, TRAVERSE CITY, MI 49686-4918
(231) 947-0506
Mailing address
2950 LAFRANIER RD, TRAVERSE CITY, MI 49686-4918
(231) 947-0506
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502002148
MI
Other
Enumeration date
11/27/2013
Last updated
11/27/2013
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