Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 59081 | CA |
NPI | 1003490657 |
---|---|
Provider Name | Stacy Ann Leveroni |
First Address | Santa Rosa, CA 95409-2637 |
Second Address | Santa Rosa, CA 95409-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2021 |
Last Update Date | 10/05/2021 |