Provider Demographics
NPI:1649602913
Name:STALEY, TRACY (CMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STALEY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CASANOVA AVE
Mailing Address - Street 2:50
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6877
Mailing Address - Country:US
Mailing Address - Phone:831-241-2778
Mailing Address - Fax:
Practice Address - Street 1:2600 GARDEN RD
Practice Address - Street 2:238
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5311
Practice Address - Country:US
Practice Address - Phone:831-241-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist