Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 070014266 | IL |
NPI | 1073682803 |
---|---|
Provider Name | Rachel Stacey |
First Address | Herrin, IL 62948-2347 |
Second Address | Herrin, IL 62948-3759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 09/03/2009 |