Provider Demographics
NPI:1841570595
Name:BERGSTRESSER, STACY (PTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BERGSTRESSER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:269-968-5975
Practice Address - Street 1:1018 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3177
Practice Address - Country:US
Practice Address - Phone:269-968-0888
Practice Address - Fax:269-968-5975
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant