| Doctor Name: | STACY DEWALD |
| NPI Number: | 1669899076 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5501016697 |
| Business Practice Address: | 21751 Ecorse Rd Taylor, MI - 481801846 |
| Business Phone Number: | 3133598001 |
| Business Fax Number: | 3133598002 |
| Mailing Address: | 33900 Harper Ave, Suite 104 CLINTON TOWNSHIP |
| State: | MI |
| Postal Code: | 48035 |
| Phone Number: | 5864169100 |
| Fax Number: | 5864169103 |
| NPI Enumeration Date: | 03/24/2014 |
| NPI Last Update Date: | 07/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501016697 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |