Provider Demographics
NPI:1750809398
Name:BROOKS, STACEY D (PT, DPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:D
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:10136 S DOS HERMANAS
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11361 S FOOTHILLS BLVD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367
Practice Address - Country:US
Practice Address - Phone:928-342-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ013231OtherLICENSE