Provider Demographics
NPI:1245271972
Name:SLOAN-GUTIERREZ, STACY (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SLOAN-GUTIERREZ
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 1:1440 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3207
Mailing Address - Country:US
Mailing Address - Phone:954-385-3595
Mailing Address - Fax:954-385-3596
Practice Address - Street 1:1440 N PARK DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3207
Practice Address - Country:US
Practice Address - Phone:954-385-3595
Practice Address - Fax:954-385-3596
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY043JOtherBCBS OF FLORIDA
FLY8194YMedicare PIN