Doctor Name: | RACHEL STACEY |
NPI Number: | 1073682803 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 070014266 |
Business Practice Address: | 3308 Logan Dr Herrin, IL - 629483759 |
Business Phone Number: | 6189934024 |
Business Fax Number: | 6189931570 |
Mailing Address: | 611 S 18th St, HERRIN |
State: | IL |
Postal Code: | 629482347 |
Phone Number: | 6189424567 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 03/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 070014266 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |