Provider Demographics
NPI:1053090050
Name:WALENTER, STACY MARIE (CMT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:WALENTER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:PLATNICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-0564
Mailing Address - Country:US
Mailing Address - Phone:406-304-0715
Mailing Address - Fax:
Practice Address - Street 1:609 WEST 8TH STREET
Practice Address - Street 2:UNIT B
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59935
Practice Address - Country:US
Practice Address - Phone:406-304-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist