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Individual
MRS. LAURIE GRACE STICKLER
Active
Individual
MRS. LAURIE GRACE STICKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010775
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-0223019
TAX ID
MI
01
—
650D114420
BLUE CROSS BLUE SHIELD
MI
01
—
LS010775
LICENSE NUMBER
MI
01
—
P35364F
BLUE CARE NETWORK
MI
Enumeration date
07/05/2005
Last updated
07/31/2020
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