Provider Demographics
NPI:1144594318
Name:TUTTLE, STACEY MICHELLE (PT)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MICHELLE
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1526 N EDGEMONT ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5260
Mailing Address - Country:US
Mailing Address - Phone:323-783-6540
Mailing Address - Fax:323-783-4459
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-6540
Practice Address - Fax:323-783-4459
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60266150225100000X
CA40865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist