Provider Demographics
NPI:1740443027
Name:ULERY, STACEY ANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANNE
Last Name:ULERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 GULF SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4898
Mailing Address - Country:US
Mailing Address - Phone:765-455-1606
Mailing Address - Fax:
Practice Address - Street 1:4851 TINCHER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221
Practice Address - Country:US
Practice Address - Phone:317-627-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002726A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant