Provider Demographics
NPI:1396973707
Name:BRANDT, STACEY L (DPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:WILBER
Mailing Address - State:NE
Mailing Address - Zip Code:68465-0692
Mailing Address - Country:US
Mailing Address - Phone:402-821-3320
Mailing Address - Fax:402-821-2177
Practice Address - Street 1:209 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WILBER
Practice Address - State:NE
Practice Address - Zip Code:68465-3144
Practice Address - Country:US
Practice Address - Phone:402-821-3320
Practice Address - Fax:402-821-2177
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist