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NPI Code Detail

MEDICARE: MRS. STACY LYNN CANNARIATO PT

MEDICARE:  MRS. STACY LYNN CANNARIATO  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 Therapist4919-24WI

General Provider Information

NPI Number : 1689954323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY LYNN CANNARIATO PT
Provider Business Mailing Address
First Line : 13706 W FERGUSON RD
Second Line :
City : NEW BERLIN
State : WI
Zip : 53151-2512
Country : US
Telephone Number : 262-794-3318
Fax Number :
Provider Business Practice Location Address
First Line : 5700 MOCKINGBIRD LN
Second Line :
City : GREENDALE
State : WI
Zip : 53129-1442
Country : US
Telephone Number : 414-423-1399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 08/25/2011

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Directions to “ MRS. STACY LYNN CANNARIATO PT” Practice Location

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