Provider Demographics
NPI:1114108792
Name:REESE, STACEY LYNN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:REESE
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 1:798 ROUTE 539
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4203
Mailing Address - Country:US
Mailing Address - Phone:609-294-4720
Mailing Address - Fax:609-294-4722
Practice Address - Street 1:798 ROUTE 539
Practice Address - Street 2:SUITE 2
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-4203
Practice Address - Country:US
Practice Address - Phone:609-294-4720
Practice Address - Fax:609-294-4722
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01266300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist