Provider Demographics
NPI:1114234002
Name:GRAZAK, STACY TRIMBLE (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:TRIMBLE
Last Name:GRAZAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:NICOLE
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2159
Mailing Address - Country:US
Mailing Address - Phone:713-910-5437
Mailing Address - Fax:713-910-5445
Practice Address - Street 1:3801 VISTA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2159
Practice Address - Country:US
Practice Address - Phone:713-910-5437
Practice Address - Fax:713-910-5445
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1197140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist