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General NPI Number Information
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NPI Number | 1104537695
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Entity Type | Individual
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Provider Name | PATRICK STOCKSTILL LMT
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Gender | Male
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 453 N BEACH RD
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City | EASTSOUND
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State | WA
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Zip | 98245-8927
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Country | US
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Telephone | 360-376-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 531 ROSARIO RD
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City | EASTSOUND
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State | WA
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Zip | 98245-8520
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Country | US
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Telephone | 510-846-2797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA.61150888
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License Number State | WA
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