Most Relevant Information
Provider Data
| NPI Number: | 1003640194 |
| Provider Name: | STACY BOSANKO LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MT132519 |
Most Important Dates
| Enumeration Date: | 08/29/2024 |
| Last Updated: | 08/29/2024 |
Provider Practice Location
5941 FIESTA DR
EL PASO
TX
799125228
Practice Location Phone/Fax
| Phone: | 9158411869 |
| Fax: |
Provider Mailing Location
5941 FIESTA DR
EL PASO
TX
799125228
Provider Mailing Phone/Fax
| Phone: | 9158411869 |
| Fax: |