Provider Demographics
NPI:1629392832
Name:PICKHARDT, STACY MARGARET (LMT, NMT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MARGARET
Last Name:PICKHARDT
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 ORANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7930
Mailing Address - Country:US
Mailing Address - Phone:727-565-6535
Mailing Address - Fax:727-447-4857
Practice Address - Street 1:600 LAKEVIEW RD
Practice Address - Street 2:SUITE E
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3355
Practice Address - Country:US
Practice Address - Phone:727-565-6535
Practice Address - Fax:727-447-4857
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist