Individual
STACI A BURRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
900 CENTENNIAL DR # 30, EAST PEORIA, IL 61611-4928
(309) 699-5400
Mailing address
1141 N NANCY ST, EAST PEORIA, IL 61611-9554
(309) 251-9707
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005049
IL
Other
Enumeration date
08/21/2020
Last updated
08/21/2020
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