Individual
STACY DEE VESCIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1305 ALEXANDER ST, CENTRALIA, WA 98531-1305
(360) 736-2823
Mailing address
8040 KENTON LN SE, OLYMPIA, WA 98501-6884
(360) 704-9790
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2305
CA
225200000X
Physical Therapy Assistant
P1 60047590
WA
Other
Enumeration date
06/02/2008
Last updated
11/15/2013
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