Provider Demographics
NPI:1750367025
Name:ROTHSTEIN, STACEY KRYSTEN (MS PT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:KRYSTEN
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:KRYSTEN
Other - Last Name:BLASBALG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:181 PATRICIA M GENOVA DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1500
Mailing Address - Country:US
Mailing Address - Phone:860-696-2536
Mailing Address - Fax:
Practice Address - Street 1:181 PATRICIA M GENOVA DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1500
Practice Address - Country:US
Practice Address - Phone:860-696-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist