Provider Demographics
NPI:1346561917
Name:RAPPAPORT, STACIE (MPT, LMT)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:MPT, LMT
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:
Other - Last Name:RAPPAPORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT, LMT
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0224
Mailing Address - Country:US
Mailing Address - Phone:406-270-0969
Mailing Address - Fax:
Practice Address - Street 1:704 ASPEN GROVE ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3481
Practice Address - Country:US
Practice Address - Phone:406-270-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3956225700000X
MT2296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist