Individual
JOHNATHON BRANDON STAKELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPY
Contact information
Practice address
2860 S CIRCLE DR # 250I, COLORADO SPRINGS, CO 80906-4113
(719) 428-7020
Mailing address
2860 S CIRCLE DR # 250I, COLORADO SPRINGS, CO 80906-4113
(719) 428-7020
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0024865
CO
Other
Enumeration date
07/06/2023
Last updated
10/22/2024
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