Provider Demographics
NPI:1568636447
Name:MENZ, STACY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:MENZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 VAN NESS AVE
Mailing Address - Street 2:204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4645
Mailing Address - Country:US
Mailing Address - Phone:415-346-3853
Mailing Address - Fax:415-563-3546
Practice Address - Street 1:1405 VAN NESS AVE
Practice Address - Street 2:204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4645
Practice Address - Country:US
Practice Address - Phone:415-346-3853
Practice Address - Fax:415-563-3546
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics