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Individual

LISA LANGLEY STACY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
5179 MARSDEN TRCE, POWDER SPRINGS, GA 30127-4321
(678) 472-4042
Mailing address
258 WOODFALL RD, CEDARTOWN, GA 30125-5904
(678) 472-4042

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
736506618A
GA
Enumeration date
10/04/2006
Last updated
11/15/2024
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