MEDICARE: DR. STACI L STOFFEL DPT

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	028656	NY

General Provider Information

NPI Number	:	1477617900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACI L STOFFEL DPT

Provider Business Mailing Address
First Line	:	5760 COMMONS PARK
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-9400
Country	:	US
Telephone Number	:	315-251-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	5760 COMMONS PARK
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-9400
Country	:	US
Telephone Number	:	315-251-0040
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	02/21/2019

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