Provider Demographics
NPI:1689282691
Name:SMITH, STACY L (RPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LEE
Other - Last Name:MCCATHVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-4526
Mailing Address - Country:US
Mailing Address - Phone:318-539-1000
Mailing Address - Fax:318-539-4085
Practice Address - Street 1:206 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3444
Practice Address - Country:US
Practice Address - Phone:318-539-4006
Practice Address - Fax:318-539-4008
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06756R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist