Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306603911 | VA |
NPI | 1013373372 |
---|---|
Provider Name | Stacy Powell |
First Address | Virginia Beach, VA 23462-5631 |
Second Address | Virginia Beach, VA 23462-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2016 |
Last Update Date | 01/01/2016 |