Provider Demographics
NPI:1326313859
Name:HARWOOD, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HARWOOD
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 1:10270 E STATE ROAD 47
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-8804
Mailing Address - Country:US
Mailing Address - Phone:317-758-0331
Mailing Address - Fax:
Practice Address - Street 1:10270 E STATE ROAD 47
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-8804
Practice Address - Country:US
Practice Address - Phone:317-758-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001911A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant