Provider Demographics
NPI:1073274429
Name:STERN, STACY BROOKE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:BROOKE
Last Name:STERN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 S SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3845
Mailing Address - Country:US
Mailing Address - Phone:312-810-2181
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3658
Practice Address - Country:US
Practice Address - Phone:323-634-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist