Provider Demographics
NPI:1730496613
Name:STALCUP, LORRAINE ARLENE (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ARLENE
Last Name:STALCUP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WHITTIER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2100
Mailing Address - Country:US
Mailing Address - Phone:734-474-0201
Mailing Address - Fax:
Practice Address - Street 1:1300 WHITTIER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2100
Practice Address - Country:US
Practice Address - Phone:734-474-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015325261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy