Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | CPOO7859T | |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1316601446 |
---|---|
Provider Name | Stacey Sinclair |
First Address | Chattanooga, TN 37421-2564 |
Second Address | Atlanta, GA 30318-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 12/11/2021 |