Provider Demographics
NPI:1396988457
Name:WILLIAMS, STACI (CMT)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:WILLIAMS
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 1:12127 HUDSON CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-4001
Mailing Address - Country:US
Mailing Address - Phone:720-227-2667
Mailing Address - Fax:
Practice Address - Street 1:11880 UPHAM ST
Practice Address - Street 2:SUITE F
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2785
Practice Address - Country:US
Practice Address - Phone:720-227-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist