Provider Demographics
NPI:1598819658
Name:FLYNN, STACI L (PT)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 NEWBURY ST
Mailing Address - Street 2:ROUTE 1 NORTHBOUND
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1001
Mailing Address - Country:US
Mailing Address - Phone:978-774-3888
Mailing Address - Fax:978-774-2992
Practice Address - Street 1:235 NEWBURY ST
Practice Address - Street 2:ROUTE 1 NORTHBOUND
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1001
Practice Address - Country:US
Practice Address - Phone:978-774-3888
Practice Address - Fax:978-774-2992
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA17681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist