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General NPI Number Information
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NPI Number | 1114235728
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Entity Type | Individual
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Provider Name | STACY L ROSS R.M.T.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 4257 MAIN ST SUITE 210
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City | WESTMINSTER
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State | CO
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Zip | 80031-5093
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Country | US
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Telephone | 720-413-3252
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Fax | 303-469-1116
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Provider Business Mailing Address
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Address Line | 13244 COLUMBINE CIR
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City | THORNTON
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State | CO
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Zip | 80241-2075
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Country | US
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Telephone | 720-413-3252
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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 | 10342
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License Number State | CO
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