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General NPI Number Information
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NPI Number | 1447280250
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Entity Type | Individual
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Provider Name | STACY L LIDDLE PT
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 911 W ANDERSON LN STE 117
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City | AUSTIN
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State | TX
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Zip | 78757-1501
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Country | US
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Telephone | 512-467-1100
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Fax | 512-467-1101
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Provider Business Mailing Address
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Address Line | 3201 BENBROOK DR
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City | AUSTIN
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State | TX
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Zip | 78757-6803
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Country | US
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Telephone | 512-420-9362
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1105211
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT022197
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License Number State | TX
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