Individual
DR. LARISSA STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
47454 ROUTE 52, KERMIT, WV 25674-8052
(304) 393-4072
(304) 393-4074
Mailing address
414 PENCO RD, WEIRTON, WV 26062-3822
(304) 393-4072
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
007169
KY
225100000X
Physical Therapist
Primary
CP004549T
WV
Other
Enumeration date
08/01/2017
Last updated
10/13/2022
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