Provider Demographics
NPI:1619204591
Name:TURK, STACEY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:TURK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:WATLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11011 S BRUNA RD
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-9571
Mailing Address - Country:US
Mailing Address - Phone:360-270-8268
Mailing Address - Fax:
Practice Address - Street 1:19319 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7442
Practice Address - Country:US
Practice Address - Phone:360-598-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2014-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60103924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist