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NPI Code Detail

MEDICARE: CODY STENNERSON MMP, LMT

MEDICARE: CODY STENNERSON MMP, LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMT-25747AZ

General Provider Information

NPI Number : 1164239943
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY STENNERSON MMP, LMT
Provider Business Mailing Address
First Line : 540 W BALBOA DR
Second Line :
City : TUCSON
State : AZ
Zip : 85705-4286
Country : US
Telephone Number : 480-980-0284
Fax Number :
Provider Business Practice Location Address
First Line : 6700 N ORACLE RD STE 501
Second Line :
City : TUCSON
State : AZ
Zip : 85704-7735
Country : US
Telephone Number : 520-809-6955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2024
Last Update Date : 12/16/2024

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