Provider Demographics
NPI:1982094884
Name:ADDAMS, STACEY E (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:E
Last Name:ADDAMS
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 1:495 GOLDEN GATE PT APT 2E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6653
Mailing Address - Country:US
Mailing Address - Phone:941-400-4339
Mailing Address - Fax:941-343-9402
Practice Address - Street 1:495 GOLDEN GATE PT APT 2E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6653
Practice Address - Country:US
Practice Address - Phone:941-400-4339
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist