Provider Demographics
NPI:1174512834
Name:GLASS, STACY A (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ENGLISH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6023
Mailing Address - Country:US
Mailing Address - Phone:252-443-6627
Mailing Address - Fax:
Practice Address - Street 1:804 ENGLISH RD STE 110
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6023
Practice Address - Country:US
Practice Address - Phone:252-443-6627
Practice Address - Fax:252-443-0709
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22141225100000X
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087390HP6Medicare PIN