Provider Demographics
NPI:1841393295
Name:LOWE, STACY ANNE (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANNE
Last Name:LOWE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANNE
Other - Last Name:MCCOOEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6260 SNOW VIEW
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6308
Mailing Address - Country:US
Mailing Address - Phone:401-480-4555
Mailing Address - Fax:
Practice Address - Street 1:1794 OLYMPIC PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-575-0345
Practice Address - Fax:435-575-0346
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62123682401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist