Healthcare Provider Details

I. General information

NPI: 1558292706
Provider Name (Legal Business Name): DR. MARIA STAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14178 S BANGERTER PKWY
DRAPER UT
84020-5497
US

IV. Provider business mailing address

1207 E BLACK FOX CT
DRAPER UT
84020-9619
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-7294
  • Fax:
Mailing address:
  • Phone: 801-550-7294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293577-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: