Provider Demographics
NPI:1134328149
Name:FEIERTAG, STACY (PTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FEIERTAG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 SW LONGBOAT WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3100
Mailing Address - Country:US
Mailing Address - Phone:772-221-3512
Mailing Address - Fax:772-221-3512
Practice Address - Street 1:227 SW MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4646
Practice Address - Country:US
Practice Address - Phone:772-781-1690
Practice Address - Fax:772-781-1691
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant