Doctor Name: | JOHN THOMAS STACK |
NPI Number: | 1962562686 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 3557-024 |
Business Practice Address: | 901 W Clairemont Ave Eau Claire, WI - 547016103 |
Business Phone Number: | 7158394359 |
Business Fax Number: | |
Mailing Address: | 716 W Grand Ave Apt 312, EAU CLAIRE |
State: | WI |
Postal Code: | 547035433 |
Phone Number: | 7158520163 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 3557-024 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
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 |