Individual
STACY HOSP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
3280 PEACHTREE RD NE, 225, ATLANTA, GA 30305-2430
(404) 254-4193
Mailing address
3777 PEACHTREE RD NE APT 1335, ATLANTA, GA 30319-5201
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT008126
GA
Other
Enumeration date
01/24/2010
Last updated
01/24/2010
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