Provider Demographics
NPI:1902364821
Name:HEINSOHN, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HEINSOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHANTILLY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1630
Mailing Address - Country:US
Mailing Address - Phone:636-262-7821
Mailing Address - Fax:
Practice Address - Street 1:10 CHANTILLY CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1630
Practice Address - Country:US
Practice Address - Phone:636-262-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist