Provider Demographics
NPI:1811036684
Name:STUCKMEYER, ARIANNE R (MPT)
Entity Type:Individual
Prefix:
First Name:ARIANNE
Middle Name:R
Last Name:STUCKMEYER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ARIANNE
Other - Middle Name:R
Other - Last Name:DE GANNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:133 W CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1101
Mailing Address - Country:US
Mailing Address - Phone:772-559-7010
Mailing Address - Fax:
Practice Address - Street 1:133 W CASCADE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1101
Practice Address - Country:US
Practice Address - Phone:772-559-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CT009963225100000X
FLPT21075225100000X
IL070025311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM053ZMedicare PIN