Provider Demographics
NPI:1952592479
Name:MICELI, STACIE R (MPT)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:R
Last Name:MICELI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1835
Mailing Address - Country:US
Mailing Address - Phone:630-553-5845
Mailing Address - Fax:
Practice Address - Street 1:1136 N MILL ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2519
Practice Address - Country:US
Practice Address - Phone:630-355-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist