Provider Demographics
NPI:1275852972
Name:BALL-DERNOSEK, STACY ANNE
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:ANNE
Last Name:BALL-DERNOSEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 WHEATLAND CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1123
Mailing Address - Country:US
Mailing Address - Phone:724-207-0052
Mailing Address - Fax:
Practice Address - Street 1:3590 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1047
Practice Address - Country:US
Practice Address - Phone:412-257-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008478225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant