Provider Demographics
NPI:1629039920
Name:TORMOLLAN, STACEY C (PT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:C
Last Name:TORMOLLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:42 MESSALONSKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-877-9577
Mailing Address - Fax:
Practice Address - Street 1:42 MESSALONSKEE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-877-9577
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist