Provider Demographics
NPI:1114965175
Name:BILLYARD, STACEY L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:BILLYARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 S MERCY RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0429
Mailing Address - Country:US
Mailing Address - Phone:480-963-2400
Mailing Address - Fax:480-726-1992
Practice Address - Street 1:3485 S MERCY RD
Practice Address - Street 2:SUITE101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0429
Practice Address - Country:US
Practice Address - Phone:480-963-2400
Practice Address - Fax:480-726-1992
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5682208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69293Medicare ID - Type Unspecified