Provider Demographics
NPI:1740605997
Name:WADAS, STACEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:WADAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 FALLING LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-5324
Mailing Address - Country:US
Mailing Address - Phone:847-924-4239
Mailing Address - Fax:
Practice Address - Street 1:18210 LA GRANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7723
Practice Address - Country:US
Practice Address - Phone:708-429-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist