Provider Demographics
NPI:1801906375
Name:LADD, STACEY J (PT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:LADD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:J
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:184 ROUTE 7 SOUTH
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0776
Mailing Address - Country:US
Mailing Address - Phone:802-893-7427
Mailing Address - Fax:802-893-7429
Practice Address - Street 1:184 ROUTE 7 SOUTH
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-0776
Practice Address - Country:US
Practice Address - Phone:802-893-7427
Practice Address - Fax:802-893-7429
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4124858OtherMVP HEALTHCARE
VT00028864OtherBLUE CROSS BLUE SHIELD
VT1006935Medicaid
VT1006935Medicaid