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General NPI Number Information
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NPI Number | 1215055561
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Entity Type | Individual
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Provider Name | STACEY RENEE DUER MSPT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 KIRKWOOD HWY
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City | WILMINGTON
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State | DE
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Zip | 19805-4917
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Country | US
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Telephone | 302-994-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 129 RAMONA LN
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City | SWEDESBORO
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State | NJ
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Zip | 08085-4071
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Country | US
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Telephone | 856-294-9062
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Fax |
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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 | 40QA01155600
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License Number State | NJ
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