Provider Demographics
NPI:1619120383
Name:PERRY, STACY (PTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3881 MAIN STREET
Mailing Address - Street 2:P.O. BOX 192
Mailing Address - City:SCOTLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 STOUFFER AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2938
Practice Address - Country:US
Practice Address - Phone:717-263-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008205225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant