Provider Demographics
NPI:1053319848
Name:RAYBUCK, STACEY L (DPT)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:RAYBUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:HEUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6 HIGHCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1299
Mailing Address - Country:US
Mailing Address - Phone:508-528-6100
Mailing Address - Fax:508-528-6304
Practice Address - Street 1:620 OLD WEST CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2912
Practice Address - Country:US
Practice Address - Phone:508-528-6100
Practice Address - Fax:508-528-6304
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA69292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0358746Medicaid
MA0358746Medicaid