Provider Demographics
NPI:1225341266
Name:ISON, STACY E (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:ISON
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 1:1815 N CAPITOL AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1288
Mailing Address - Country:US
Mailing Address - Phone:317-924-8636
Mailing Address - Fax:317-921-0237
Practice Address - Street 1:1815 N CAPITOL AVE
Practice Address - Street 2:STE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1288
Practice Address - Country:US
Practice Address - Phone:317-924-8636
Practice Address - Fax:317-921-0237
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010364A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05010364AOtherPHYSICAL THERAPIST LICENSE NUMBER