Healthcare Provider Details

I. General information

NPI: 1407153414
Provider Name (Legal Business Name): STACIE A SOUCY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

IV. Provider business mailing address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-9008
  • Fax: 714-897-7949
Mailing address:
  • Phone: 714-891-9008
  • Fax: 714-897-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: