Provider Demographics
NPI:1962013474
Name:STABLE FOUNDATIONS THERAPY PLLC
Entity Type:Organization
Organization Name:STABLE FOUNDATIONS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:623-606-0883
Mailing Address - Street 1:12115 N PEAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5589
Mailing Address - Country:US
Mailing Address - Phone:623-606-0883
Mailing Address - Fax:
Practice Address - Street 1:12115 N PEAKS PKWY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-5589
Practice Address - Country:US
Practice Address - Phone:623-606-0883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center