Provider Demographics
NPI:1740932672
Name:SCHAEFER, STACY LYNNE (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNNE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1136 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5130
Mailing Address - Country:US
Mailing Address - Phone:920-946-3432
Mailing Address - Fax:
Practice Address - Street 1:3100 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1994
Practice Address - Country:US
Practice Address - Phone:920-457-5770
Practice Address - Fax:920-457-5951
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4543-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4543-24OtherWI PT LICENSE NUMBER