Provider Demographics
NPI:1518921154
Name:SCHREIBEIS, STACIE C (PTA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:C
Last Name:SCHREIBEIS
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:C
Other - Last Name:VISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11915 E BROADWAY AVE
Mailing Address - Street 2:101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4997
Mailing Address - Country:US
Mailing Address - Phone:509-228-9404
Mailing Address - Fax:509-228-9403
Practice Address - Street 1:11915 E BROADWAY AVE
Practice Address - Street 2:101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4997
Practice Address - Country:US
Practice Address - Phone:509-228-9404
Practice Address - Fax:509-228-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WAP160045502225200000X
IDPTA-2497225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer