Provider Demographics
NPI:1073816146
Name:USTER, STACEY ARLEENE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ARLEENE
Last Name:USTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630001
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0001
Mailing Address - Country:US
Mailing Address - Phone:303-660-6493
Mailing Address - Fax:303-346-9727
Practice Address - Street 1:4735 LAURELGLEN LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-6928
Practice Address - Country:US
Practice Address - Phone:330-660-6493
Practice Address - Fax:303-346-9727
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid