Provider Demographics
NPI:1629685441
Name:HARDEE, STACY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:HARDEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT SOPRIS DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4622
Mailing Address - Country:US
Mailing Address - Phone:970-945-2306
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT SOPRIS DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4622
Practice Address - Country:US
Practice Address - Phone:970-945-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist