Provider Demographics
NPI:1255472593
Name:MARLO, STACEY JONES (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JONES
Last Name:MARLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 SE 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:CROSS CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32628-5836
Mailing Address - Country:US
Mailing Address - Phone:352-262-2570
Mailing Address - Fax:
Practice Address - Street 1:1315 NW 21ST AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1977
Practice Address - Country:US
Practice Address - Phone:352-493-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17593225100000X
FLPT 17593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist