Provider Demographics
NPI:1508001231
Name:TURNER, STACEY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:TURNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52581 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3166
Mailing Address - Country:US
Mailing Address - Phone:586-323-2381
Mailing Address - Fax:
Practice Address - Street 1:14145 SIMONE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3228
Practice Address - Country:US
Practice Address - Phone:586-566-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist