Provider Demographics
NPI:1457818031
Name:INZERILLO, STACY JO (LMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:INZERILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1828
Mailing Address - Country:US
Mailing Address - Phone:507-895-8100
Mailing Address - Fax:608-268-9710
Practice Address - Street 1:306 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1828
Practice Address - Country:US
Practice Address - Phone:507-895-8100
Practice Address - Fax:608-268-9710
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist