Individual
STACEY L CORRADO
Active
Individual
STACEY L CORRADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03366
KS
225100000X
Physical Therapist
110767
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255386165
BCBS KS
KS
01
—
31209096
BCBS KC
—
01
—
KA2868003
MEDICARE PTAN
KS
01
—
MA4370066
MEDICARE PTAN
MO
Enumeration date
05/23/2006
Last updated
02/11/2014
Update your record
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