Healthcare Provider Details

I. General information

NPI: 1942418751
Provider Name (Legal Business Name): STACEY CIRAKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 BROOK HOLW
GAHANNA OH
43230-6276
US

IV. Provider business mailing address

78 ASPEN LN
PATASKALA OH
43062-9002
US

V. Phone/Fax

Practice location:
  • Phone: 614-414-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-010717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: