Provider Demographics
NPI:1760730428
Name:HOUSE, STACY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:HOUSE
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 1:4031 SWIFT WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3306
Mailing Address - Country:US
Mailing Address - Phone:850-643-1664
Mailing Address - Fax:
Practice Address - Street 1:2410 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5325
Practice Address - Country:US
Practice Address - Phone:850-385-6185
Practice Address - Fax:850-385-2580
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist