Provider Demographics
NPI:1659040061
Name:STUBER, STACEY ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:STUBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7653 PARADE DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2145
Mailing Address - Country:US
Mailing Address - Phone:404-324-7874
Mailing Address - Fax:
Practice Address - Street 1:3405 DALLAS HWY SW STE 601
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6427
Practice Address - Country:US
Practice Address - Phone:770-438-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist