Provider Demographics
NPI:1598063547
Name:FOOTE, STACEY JOYCE (PT)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:JOYCE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5345
Mailing Address - Country:US
Mailing Address - Phone:928-474-0429
Mailing Address - Fax:
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5345
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist