Individual
STACIE D VAN PELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2835 N NEBRASKA AVE, YORK, NE 68467-8096
(402) 362-8636
(308) 697-4179
Mailing address
2835 N NEBRASKA AVE, YORK, NE 68467-8096
(402) 362-8636
(308) 697-4179
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1859
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272277
MEDICARE ID-PHYSICAL THERAPY
NE
01
—
36518
BCBS
NE
01
—
650018006
RR MEDICARE
NE
Enumeration date
10/06/2006
Last updated
04/10/2013
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