Provider Demographics
NPI:1417359241
Name:UNKRAUT, STACEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:UNKRAUT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 WINTON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1140
Mailing Address - Country:US
Mailing Address - Phone:513-363-5339
Mailing Address - Fax:513-363-5340
Practice Address - Street 1:5425 WINTON RIDGE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1140
Practice Address - Country:US
Practice Address - Phone:513-363-5339
Practice Address - Fax:513-363-5340
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist