Provider Demographics
NPI:1851924229
Name:CLAWSON, STACY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:ZINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1507 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2711
Mailing Address - Country:US
Mailing Address - Phone:620-566-7212
Mailing Address - Fax:
Practice Address - Street 1:510 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1101
Practice Address - Country:US
Practice Address - Phone:620-564-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03051225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant