Provider Demographics
NPI:1811367725
Name:BARBER, STACIE C (PT)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:C
Last Name:BARBER
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 1:2103 W PARKSIDE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1245
Mailing Address - Country:US
Mailing Address - Phone:602-675-0325
Mailing Address - Fax:949-553-3561
Practice Address - Street 1:2103 W PARKSIDE LN STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1245
Practice Address - Country:US
Practice Address - Phone:602-734-5610
Practice Address - Fax:949-553-3561
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist