Provider Demographics
NPI:1023043452
Name:HOWELL, STACEY LEANNE (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEANNE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 KIMBROUGH WOODS PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-5111
Mailing Address - Country:US
Mailing Address - Phone:662-769-0622
Mailing Address - Fax:
Practice Address - Street 1:2281 KIMBROUGH WOODS PL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-5111
Practice Address - Country:US
Practice Address - Phone:662-769-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3647967Medicare ID - Type Unspecified