Provider Demographics
NPI:1114138294
Name:DEERING, STACY M (PT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:DEERING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3547
Mailing Address - Country:US
Mailing Address - Phone:540-636-0390
Mailing Address - Fax:
Practice Address - Street 1:1000 N SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3547
Practice Address - Country:US
Practice Address - Phone:540-636-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist