Provider Demographics
NPI:1245427368
Name:RAACK, STACY CAMPBELL (PT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CAMPBELL
Last Name:RAACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:KAYE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1635 PHOENIX BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5549
Mailing Address - Country:US
Mailing Address - Phone:770-996-0663
Mailing Address - Fax:770-996-0422
Practice Address - Street 1:2540 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8605
Practice Address - Country:US
Practice Address - Phone:770-644-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist