Provider Demographics
NPI:1437233822
Name:RICHARDS, STACEY L (MPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:RICHARDS
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 1:8920 ST RT 550
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784
Mailing Address - Country:US
Mailing Address - Phone:740-678-7449
Mailing Address - Fax:
Practice Address - Street 1:809 FARSON STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714
Practice Address - Country:US
Practice Address - Phone:740-423-1500
Practice Address - Fax:740-423-1504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.011612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist