Provider Demographics
NPI:1851353619
Name:FRITZ, STACY JEAN (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JEAN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 N 163RD PLZ
Mailing Address - Street 2:APT 204
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2125
Mailing Address - Country:US
Mailing Address - Phone:402-968-0762
Mailing Address - Fax:402-493-6979
Practice Address - Street 1:7818 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3412
Practice Address - Country:US
Practice Address - Phone:402-493-6808
Practice Address - Fax:402-493-6979
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2285225100000X
IA03735225100000X
CO8676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00443767OtherMEDICARE RR
NEP00443767OtherMEDICARE RR
IAI13133Medicare PIN