Provider Demographics
NPI:1871034561
Name:GARRETT, STACEY (MPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7568
Mailing Address - Fax:
Practice Address - Street 1:1810 SHADY BROOK ST STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3993
Practice Address - Country:US
Practice Address - Phone:931-388-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0500594A225100000X
TN12949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist