Individual
STACEY PESTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
300 S 18TH ST, MOUNT VERNON, WA 98274-4661
(360) 424-1320
Mailing address
25117 SW PARKWAY AVE, SUITE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160562657
WA
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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