Healthcare Provider Details

I. General information

NPI: 1487742417
Provider Name (Legal Business Name): STACEY KINSEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 86TH ST
URBANDALE IA
50322-4201
US

IV. Provider business mailing address

8101 BIRCHWOOD CT SUITE S
JOHNSTON IA
50131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-3406
  • Fax: 515-276-5141
Mailing address:
  • Phone: 515-471-9720
  • Fax: 515-471-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3667
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: