Provider Demographics
NPI:1922298082
Name:SEIFRIED, STACEY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:SEIFRIED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GLENCOE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2837
Mailing Address - Country:US
Mailing Address - Phone:617-803-7619
Mailing Address - Fax:
Practice Address - Street 1:68 GLENCOE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2837
Practice Address - Country:US
Practice Address - Phone:617-803-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist