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General NPI Number Information
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NPI Number | 1770855702
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Entity Type | Individual
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Provider Name | BEVERLY M STASIS L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 3444 EAST LAKE RD SUITE 412
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-492-0970
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Fax | 727-286-6204
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Provider Business Mailing Address
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Address Line | 3444 EAST LAKE RD SUITE 412
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-492-0970
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Fax | 727-286-6204
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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 | MA57967
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License Number State | FL
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