MEDICARE: BRANDI STACY PT

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	08203	LA

General Provider Information

NPI Number	:	1134402589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI STACY PT

Provider Business Mailing Address
First Line	:	1756 GOLDEN RD
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70665-8199
Country	:	US
Telephone Number	:	337-405-9379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 GOLDEN RD
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70665-8199
Country	:	US
Telephone Number	:	337-405-9379
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	02/05/2020

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Directions to “ BRANDI STACY PT” Practice Location

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