Provider Demographics
NPI:1538284823
Name:STANLEY, ELIZABETH ANN (LMT, PH D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LMT, PH D
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1954 NE WELLS ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6434
Mailing Address - Country:US
Mailing Address - Phone:541-350-1613
Mailing Address - Fax:541-617-5715
Practice Address - Street 1:1954 NE WELLS ACRES RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6434
Practice Address - Country:US
Practice Address - Phone:541-350-1613
Practice Address - Fax:541-617-5715
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7858225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist