Individual
STASHA PROVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
277 PLEASANT ST UNIT 109, PASADENA, CA 91101-3198
(213) 434-8672
Mailing address
277 PLEASANT ST UNIT 109, PASADENA, CA 91101-3198
(213) 434-8672
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
06/19/2021
Last updated
06/19/2021
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