Provider Demographics
NPI:1982178026
Name:CHRISTENSEN, STACY GREEN (LPTA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:GREEN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-3662
Mailing Address - Country:US
Mailing Address - Phone:256-710-4474
Mailing Address - Fax:
Practice Address - Street 1:2380 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4809
Practice Address - Country:US
Practice Address - Phone:931-762-9418
Practice Address - Fax:931-766-0573
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA8415225200000X
TNPTA0000006474225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant