Provider Demographics
NPI:1144269473
Name:FRITZ, STACY L (PHD, PT)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 NORTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1563
Mailing Address - Country:US
Mailing Address - Phone:803-622-5628
Mailing Address - Fax:803-777-8422
Practice Address - Street 1:PT CLINIC, DEPARTMENT OF EXERCISE SCIENCE
Practice Address - Street 2:UNIVERSITY OF SOUTH CAROLINA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49622251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology