Provider Demographics
NPI:1720836166
Name:MURPHY, STACY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:MURPHY
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 1:4992 SHALLOW RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6201
Mailing Address - Country:US
Mailing Address - Phone:315-882-6697
Mailing Address - Fax:
Practice Address - Street 1:4992 SHALLOW RIDGE RD NE
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6201
Practice Address - Country:US
Practice Address - Phone:315-882-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist