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Individual

STACI CELESTE WOODS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
457 S FITNESS PL, SUITE 100, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338
Mailing address
457 S FITNESS PL, SUITE 100, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT 1598
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010150739
BLUE SHIELD
01
TC977
BLUE CROSS
Enumeration date
10/06/2006
Last updated
07/08/2007
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