Individual
STACEY ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
40601 N GANTZEL RD STE 103, SAN TAN VALLEY, AZ 85140-7036
(602) 648-5444
(602) 772-3801
Mailing address
25408 S 197TH ST, QUEEN CREEK, AZ 85142-8992
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
8913
AZ
363AS0400X
Surgical Physician Assistant
8913
AZ
Other
Enumeration date
02/09/2015
Last updated
03/11/2024
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