Provider Demographics
NPI:1619206869
Name:PEARL, STACY LAUREN (MPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LAUREN
Last Name:PEARL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16253 LAGUNA CANYON RD
Mailing Address - Street 2:STE 140
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3613
Mailing Address - Country:US
Mailing Address - Phone:949-754-1344
Mailing Address - Fax:949-754-1351
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-754-1344
Practice Address - Fax:949-754-1351
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist