Provider Demographics
NPI:1134402589
Name:STACY, BRANDI (PT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:STACY
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 1:1756 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8199
Mailing Address - Country:US
Mailing Address - Phone:337-405-9379
Mailing Address - Fax:
Practice Address - Street 1:1756 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-8199
Practice Address - Country:US
Practice Address - Phone:337-405-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist