Provider Demographics
NPI:1558444166
Name:SPURLIN, STACY J (PTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:SPURLIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 LAKEWOOD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-3712
Mailing Address - Country:US
Mailing Address - Phone:423-365-2232
Mailing Address - Fax:
Practice Address - Street 1:569 LAKEWOOD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-3712
Practice Address - Country:US
Practice Address - Phone:423-365-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000002871225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00315004OtherRAILROADMEDICARE
TN4115301OtherBCBST
TNP00315004OtherRAILROADMEDICARE