Healthcare Provider Details

I. General information

NPI: 1073514469
Provider Name (Legal Business Name): STACEY MATTHEWS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 BRITTON RD
PERRY MI
48872-9716
US

IV. Provider business mailing address

3737 BRITTON RD
PERRY MI
48872-9716
US

V. Phone/Fax

Practice location:
  • Phone: 517-625-0772
  • Fax: 517-625-0778
Mailing address:
  • Phone: 517-625-0772
  • Fax: 517-625-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberSM010543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: