Provider Demographics
NPI:1578530093
Name:BIERCE, STACY A (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:BIERCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:ROMOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:8936 SOUTHPOINTE DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7507
Practice Address - Country:US
Practice Address - Phone:317-888-3838
Practice Address - Fax:317-888-3838
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007138A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200485020Medicaid
IN000000334938OtherANTHEM ID
IN000000334938OtherANTHEM ID