Provider Demographics
NPI:1679939250
Name:CARONE, STACY MARIE (MA, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:CARONE
Suffix:
Gender:F
Credentials:MA, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E LANCASTER AVE
Mailing Address - Street 2:DAVIS CENTER FIRST FLOOR
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1603
Mailing Address - Country:US
Mailing Address - Phone:610-519-4557
Mailing Address - Fax:
Practice Address - Street 1:800 E LANCASTER AVE
Practice Address - Street 2:DAVIS CENTER FIRST FLOOR
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1603
Practice Address - Country:US
Practice Address - Phone:610-519-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0042102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer