Provider Demographics
NPI:1407255771
Name:SCHREIBER, STACY L
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:STRIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1161 OLD VINCENNES TRL
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4115
Mailing Address - Country:US
Mailing Address - Phone:618-795-0783
Mailing Address - Fax:
Practice Address - Street 1:1050 FOUNTAIN LAKES DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2595
Practice Address - Country:US
Practice Address - Phone:779-713-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist