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Individual

DR. STEPHEN J BACIAK II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
650 JOEL DRIVE, FORT CAMPBELL, KY 42223
(555) 321-4567
Mailing address
650 JOEL DRIVE, FORT CAMPBELL, KY 42223

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12100
CT
225100000X
Physical Therapist
PT 26233
FL

Other

Enumeration date
12/08/2011
Last updated
12/11/2024
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