Provider Demographics
NPI:1457960130
Name:STUFF, CHLOE J (LMT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:J
Last Name:STUFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:JUSTINE
Other - Last Name:ANDREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1930 W PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-8578
Mailing Address - Country:US
Mailing Address - Phone:928-308-0587
Mailing Address - Fax:
Practice Address - Street 1:172 E MERRITT ST STE C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2027
Practice Address - Country:US
Practice Address - Phone:928-642-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25916225700000X
AZ29176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist