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NPI Code Detail

MEDICARE: MRS. STACY MICHELLE FORSTHOEFEL PT

MEDICARE: MRS. STACY MICHELLE FORSTHOEFEL 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
1225100000XPhysical TherapistPT25500FL

General Provider Information

NPI Number : 1255650420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY MICHELLE FORSTHOEFEL PT
Provider Business Mailing Address
First Line : 1512 SUNSET LN
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-4538
Country : US
Telephone Number : 850-508-2763
Fax Number :
Provider Business Practice Location Address
First Line : 1725 HERMITAGE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-7709
Country : US
Telephone Number : 850-325-6301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2010
Last Update Date : 03/01/2013

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