MEDICARE: JANELLE STACY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	63398	OR

General Provider Information

NPI Number	:	1144876533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE STACY PT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-8930
Fax Number	:

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD STE C
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-965-6400
Fax Number	:	503-965-9555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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