Provider Demographics
NPI:1750650784
Name:ANHEIER, STACEY ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ELIZABETH
Last Name:ANHEIER
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 1:6221 OMAHA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5521
Mailing Address - Country:US
Mailing Address - Phone:408-656-7258
Mailing Address - Fax:
Practice Address - Street 1:88 ROWLAND WAY STE 250
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5062
Practice Address - Country:US
Practice Address - Phone:415-898-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist