Provider Demographics
NPI:1043224967
Name:BIERLY, STACY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:BIERLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GAS LIGHT DR
Mailing Address - Street 2:#10
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2235
Mailing Address - Country:US
Mailing Address - Phone:781-337-5814
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-331-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist