Provider Demographics
NPI:1831144096
Name:FOX, STACY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 S TALBOLT STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ST. MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2606
Mailing Address - Country:US
Mailing Address - Phone:410-745-8025
Mailing Address - Fax:410-745-8495
Practice Address - Street 1:1110 S TALBOLT STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:ST. MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2606
Practice Address - Country:US
Practice Address - Phone:410-745-8025
Practice Address - Fax:410-745-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47-3586398OtherFEIN