Provider Demographics
NPI:1720098965
Name:HILLEY, STACY E (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:HILLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SPRING STATION RD
Mailing Address - Street 2:STE D
Mailing Address - City:FRANKLIN SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30639
Mailing Address - Country:US
Mailing Address - Phone:706-246-0542
Mailing Address - Fax:706-246-0543
Practice Address - Street 1:68 SPRING STATION RD
Practice Address - Street 2:STE D
Practice Address - City:FRANKLIN SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30639-3063
Practice Address - Country:US
Practice Address - Phone:706-246-0542
Practice Address - Fax:706-246-0543
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6855Medicare ID - Type UnspecifiedPROVIDER GROUP #
GA65BBCSTMedicare ID - Type UnspecifiedINDIVIDUAL #
GAQ30287Medicare UPIN