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Individual
STACEY J LADD
Active
Individual
STACEY J LADD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0400002594
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00028864
BLUE CROSS BLUE SHIELD
VT
05
—
1006935
—
VT
01
—
4124858
MVP HEALTHCARE
—
Enumeration date
08/30/2006
Last updated
11/30/2007
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