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Individual
DR. MARY JEAN STACK
Active
Individual
DR. MARY JEAN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305212350
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508262734
NPI
—
01
—
PT872017
LICENSE
DC
Enumeration date
11/17/2014
Last updated
06/04/2026
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