Provider Demographics
NPI:1407147507
Name:STONE, STACEY (SHC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:SHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N CALGARY CT
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4906
Mailing Address - Country:US
Mailing Address - Phone:208-773-0746
Mailing Address - Fax:
Practice Address - Street 1:609 N CALGARY CT
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4906
Practice Address - Country:US
Practice Address - Phone:208-773-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSHC 1262172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist