Individual
STACI LOUISE WHITSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12 RED MAPLE CT, CENTRAL CITY, IA 52214-9537
(319) 350-6990
Mailing address
12 RED MAPLE CT, CENTRAL CITY, IA 52214-9537
(319) 350-6990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02696
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100
JOHN DEERE
—
01
—
06745
WELLMARK BCBS
IA
01
—
421494864
TRICARE
—
01
—
42149864
PRIVATE HEALTH CARE SYSTE
—
01
—
7202080
AETNA
—
Enumeration date
08/22/2006
Last updated
04/07/2011
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