Individual
STACEY EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3737 LANDINGS DR, A4, FORT COLLINS, CO 80525-3159
(720) 299-4458
Mailing address
3737 LANDINGS DR, A4, FORT COLLINS, CO 80525-3159
(720) 299-4458
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
12391
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12391
MEDICARE
CO
Enumeration date
11/15/2012
Last updated
11/15/2012
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