Provider Demographics
NPI:1588618623
Name:BRATCHER, STACIE D (PT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:D
Last Name:BRATCHER
Suffix:
Gender:F
Credentials:PT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 GRIDER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4761
Mailing Address - Country:US
Mailing Address - Phone:270-991-4904
Mailing Address - Fax:859-296-6304
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:SUITE 350
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:270-991-4904
Practice Address - Fax:859-296-6304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY002865OtherPT STATE LICENSE