Provider Demographics
NPI:1114235728
Name:ROSS, STACY L (RMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13244 COLUMBINE CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2075
Mailing Address - Country:US
Mailing Address - Phone:720-413-3252
Mailing Address - Fax:
Practice Address - Street 1:4257 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-5093
Practice Address - Country:US
Practice Address - Phone:720-413-3252
Practice Address - Fax:303-469-1116
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist