Provider Demographics
NPI:1083730006
Name:THOMAS, STACEY FLING (MSPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:FLING
Last Name:THOMAS
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 1:4009 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1912
Mailing Address - Country:US
Mailing Address - Phone:804-359-6665
Mailing Address - Fax:804-340-2829
Practice Address - Street 1:THE HERMITAGE RICHMOND
Practice Address - Street 2:1600 WESTWOOD AVE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227
Practice Address - Country:US
Practice Address - Phone:804-474-1859
Practice Address - Fax:804-340-2829
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist