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General NPI Number Information
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NPI Number | 1164319729
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Entity Type | Individual
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Provider Name | STEPHEN BAXTER LMT
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Gender | Male
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 147 N CORTEZ ST # 107
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City | PRESCOTT
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State | AZ
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Zip | 86301-3015
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Country | US
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Telephone | 928-778-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 310 N ALARCON ST APT 1
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City | PRESCOTT
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State | AZ
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Zip | 86301-2661
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Country | US
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Telephone | 775-220-8209
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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 | 28992
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License Number State | AZ
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