Healthcare Provider Details

I. General information

NPI: 1396672762
Provider Name (Legal Business Name): STEPHANIE ROBERTS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 N BERNICE PL
TUCSON AZ
85743-9718
US

IV. Provider business mailing address

6442 N BERNICE PL
TUCSON AZ
85743-9718
US

V. Phone/Fax

Practice location:
  • Phone: 520-345-3095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-23299
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: