Provider Demographics
NPI:1972834182
Name:FLETCHER, STACEY EVANS (DPT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:EVANS
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:981 HIGH HOUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3510
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:3150 ROGERS RD STE 216
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7068
Practice Address - Country:US
Practice Address - Phone:919-229-8363
Practice Address - Fax:919-229-8356
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23119225100000X
NCP18328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist