Provider Demographics
NPI:1245822824
Name:HULSEY-BROWN, STACY LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:HULSEY-BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4025 WOODLAND PARK BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4301
Mailing Address - Country:US
Mailing Address - Phone:817-792-2030
Mailing Address - Fax:817-792-2031
Practice Address - Street 1:4025 WOODLAND PARK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-4301
Practice Address - Country:US
Practice Address - Phone:817-792-2030
Practice Address - Fax:817-792-2031
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116895261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1116895OtherPT LICENSE