MEDICARE: STACY JO NEEDHAM

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	1874	NV

General Provider Information

NPI Number	:	1356093637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY JO NEEDHAM

Provider Business Mailing Address
First Line	:	2320 IONE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7943
Country	:	US
Telephone Number	:	725-200-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 IONE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7943
Country	:	US
Telephone Number	:	725-200-3400
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ STACY JO NEEDHAM ” Practice Location

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