MEDICARE: MATTHEW STACY MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT1782	AR

General Provider Information

NPI Number	:	1063593010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW STACY MSPT

Provider Business Mailing Address
First Line	:	1914 U STREET
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015
Country	:	US
Telephone Number	:	501-580-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 I 630 EXIT 7
Second Line	:	BAPTIST HEALTH REHAB INSTITUTE
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7299
Country	:	US
Telephone Number	:	501-202-7589
Fax Number	:	501-202-7141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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