Provider Demographics
NPI:1477849131
Name:LONGLEY, STACEY LOUISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LOUISE
Last Name:LONGLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7313
Mailing Address - Country:US
Mailing Address - Phone:713-223-1800
Mailing Address - Fax:
Practice Address - Street 1:4141 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7313
Practice Address - Country:US
Practice Address - Phone:713-223-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist