Provider Demographics
NPI:1437871464
Name:COLLIER, STACY (LMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EAGLE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2601
Mailing Address - Country:US
Mailing Address - Phone:907-687-4886
Mailing Address - Fax:888-440-0561
Practice Address - Street 1:140 EAGLE ST APT 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2601
Practice Address - Country:US
Practice Address - Phone:907-687-4886
Practice Address - Fax:888-440-0561
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK199635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist