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General NPI Number Information
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NPI Number | 1164239943
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Entity Type | Individual
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Provider Name | CODY STENNERSON MMP, LMT
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Gender | Male
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 6700 N ORACLE RD STE 501
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City | TUCSON
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State | AZ
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Zip | 85704-7735
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Country | US
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Telephone | 520-809-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 540 W BALBOA DR
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City | TUCSON
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State | AZ
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Zip | 85705-4286
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Country | US
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Telephone | 480-980-0284
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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 | MT-25747
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License Number State | AZ
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