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General NPI Number Information
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NPI Number | 1881716454
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Entity Type | Individual
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Provider Name | STACEY ANN FARMER PTA - IS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 2250 HICKORY RD SUITE 240
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1047
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Country | US
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Telephone | 180-087-9447
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Fax | 610-834-7525
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Provider Business Mailing Address
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Address Line | 4074 THOMPSON RD
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1407
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Country | US
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Telephone | 610-828-1438
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI001015
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License Number State | PA
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