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NPI Code Detail

MEDICARE: STACIE DOSS MPT

MEDICARE: STACIE DOSS MPT
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
1225100000XPhysical Therapist2005022714MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00361867OTHERMORAILROAD MEDICARE

General Provider Information

NPI Number : 1205888104
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIE DOSS MPT
Provider Business Mailing Address
First Line : 2454 W CLAY ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-2548
Country : US
Telephone Number : 636-916-4625
Fax Number : 636-916-4628
Provider Business Practice Location Address
First Line : 2454 W CLAY ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-2548
Country : US
Telephone Number : 636-949-3926
Fax Number : 636-949-3928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 08/14/2012

Similar Medicare Providers

1972557924 — LISA M WILLIAMS DPT
Practice Location Address:
2454 W CLAY ST
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1528223070 — BABAR ENTERPRISES LLC
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1316177637 — HEATHER E BANIAK PT
Practice Location Address:
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1043525298 — MRS. STACEY KRISTEN BATSON DPT
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Directions to “ STACIE DOSS MPT” Practice Location

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