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General NPI Number Information
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NPI Number | 1144594318
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Entity Type | Individual
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Provider Name | STACEY MICHELLE TUTTLE PT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 1526 N EDGEMONT ST 4TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90027-5260
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Country | US
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Telephone | 323-783-6540
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Fax | 323-783-4459
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Provider Business Mailing Address
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Address Line | 1526 N EDGEMONT ST 4TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90027-5260
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Country | US
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Telephone | 323-783-6540
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Fax | 323-783-4459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60266150
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40865
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License Number State | CA
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