Individual
STACEY LEE FLEETWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
4911 STATE AVE, KANSAS CITY, KS 66102-1749
(913) 287-8851
Mailing address
4911 STATE AVE, KANSAS CITY, KS 66102-1749
(913) 287-8851
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-02852
KS
225100000X
Physical Therapist
2004009998
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-02852
STATE LICENSE
KS
01
—
2004009998
STATE LICENSE
MO
Enumeration date
02/21/2007
Last updated
03/15/2011
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