Individual
WILLIAM STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
590 NW 23RD ST, REDMOND, OR 97756-6969
(541) 460-0356
Mailing address
967 NW POPLAR AVE, REDMOND, OR 97756-1061
(541) 460-0356
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8011
OR
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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