Individual
STACI A HILDEBRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
702 BARRETT BLVD, STE B, HENDERSON, KY 42420-4931
(270) 631-4100
(270) 631-4101
Mailing address
7300 E INDIANA ST, STE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005465
KY
225100000X
Physical Therapist
05008671A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378690
BLUE CROSS BLUE SHIELD
IN
01
—
000000558412
BLUE CROSS BLUE SHIELD
IN
01
—
000000721633
BLUE CROSS BLUE SHIELD
KY
05
—
200818510
—
IN
Enumeration date
12/06/2005
Last updated
02/14/2012
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