Provider Demographics
NPI:1831271006
Name:THOMAS, STACIE MARIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1623 SCENIC MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1886
Mailing Address - Country:US
Mailing Address - Phone:281-361-4395
Mailing Address - Fax:936-336-9083
Practice Address - Street 1:1200 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-5718
Practice Address - Country:US
Practice Address - Phone:936-336-2241
Practice Address - Fax:936-336-9083
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6155OtherBC/BS
TX456810Medicare ID - Type UnspecifiedMEDICARE