| Doctor Name: | MRS. STACY JO KETTLER |
| NPI Number: | 1801056064 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 2000152525 |
| Business Practice Address: | 1108 Clarke St De Soto, MO - 630202706 |
| Business Phone Number: | 6365860895 |
| Business Fax Number: | |
| Mailing Address: | 2827 Heather Wood Ln, FESTUS |
| State: | MO |
| Postal Code: | 630283140 |
| Phone Number: | 6369312327 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2008 |
| NPI Last Update Date: | 06/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2000152525 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |