Provider Demographics
NPI:1184878951
Name:THURY, STACEY LEE (MPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:THURY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20140 371ST AVE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON
Mailing Address - State:SD
Mailing Address - Zip Code:57381-6928
Mailing Address - Country:US
Mailing Address - Phone:605-458-2245
Mailing Address - Fax:
Practice Address - Street 1:300 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1238
Practice Address - Country:US
Practice Address - Phone:605-853-2421
Practice Address - Fax:605-853-0333
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist