MEDICARE: SUSAN STAGL LESPERANCE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	T1120093	AZ

General Provider Information

NPI Number	:	1356148654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN STAGL LESPERANCE LMT

Provider Business Mailing Address
First Line	:	2910 E CHULA VISTA DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-2404
Country	:	US
Telephone Number	:	520-490-4928
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 E FORT LOWELL RD STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1682
Country	:	US
Telephone Number	:	520-490-4928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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