Individual
SCOTT STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12216 S AVERS AVE, ALSIP, IL 60803-1302
(708) 702-0172
Mailing address
12216 S AVERS AVE, ALSIP, IL 60803-1302
(708) 702-0172
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007136
IL
Other
Enumeration date
05/03/2024
Last updated
03/03/2025
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