Provider Demographics
NPI:1598798175
Name:DIONNE, STACEY L (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:DIONNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:D
Other - Last Name:DIONNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5100 W. ELDORADO PKWY #102-20FC
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072
Mailing Address - Country:US
Mailing Address - Phone:817-514-0519
Mailing Address - Fax:817-514-8861
Practice Address - Street 1:5000 WESTERN CENTER BLVD
Practice Address - Street 2:STE 220
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-2197
Practice Address - Country:US
Practice Address - Phone:817-514-0519
Practice Address - Fax:817-514-8861
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0216970-01Medicaid
TXTXB104690OtherMEDICARE B