Individual
LACEY ANNE STALDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5993 COHO ST, UNIT C, JBER, AK 99506-3605
(231) 557-1240
Mailing address
5993 COHO ST, UNIT C, JBER, AK 99506-3605
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
103167
AK
Other
Enumeration date
09/07/2015
Last updated
09/07/2015
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