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Individual

JOHN THOMAS STACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
901 W CLAIREMONT AVE, EAU CLAIRE, WI 54701-6103
(715) 839-4359
Mailing address
716 W GRAND AVE APT 312, EAU CLAIRE, WI 54703-5433
(715) 852-0163

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3557-024
WI

Other

Enumeration date
12/11/2006
Last updated
07/08/2007
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