Healthcare Provider Details

I. General information

NPI: 1013272913
Provider Name (Legal Business Name): STACY RENEE DOWNS D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2012
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date: 06/13/2016
Reactivation Date: 02/09/2017

III. Provider practice location address

14201 W SUNRISE BLVD STE 107
SUNRISE FL
33323-3207
US

IV. Provider business mailing address

2208 S CYPRESS BEND DR APT 503
POMPANO BEACH FL
33069-4431
US

V. Phone/Fax

Practice location:
  • Phone: 954-756-2818
  • Fax:
Mailing address:
  • Phone: 754-777-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number33727
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number33727
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number33727
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number33727
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005790
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: