Individual
STACEY ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
6050 SYCAMORE LN N, PLYMOUTH, MN 55442-1402
(651) 968-5462
Mailing address
524 2ND AVE NE, OSSEO, MN 55369-1111
(763) 639-8094
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3841
MN
2255A2300X
Athletic Trainer
A160417201
WA
Other
Enumeration date
04/23/2015
Last updated
02/01/2026
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