Provider Demographics
NPI:1326274630
Name:GOOD, STACY R (DPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:GOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:R
Other - Last Name:MUSTARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:3291 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6208
Practice Address - Country:US
Practice Address - Phone:309-347-0090
Practice Address - Fax:309-347-0098
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist