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NPI Code Detail

MEDICARE: STACEY SCOTT PTA

MEDICARE: STACEY SCOTT PTA
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1578519898
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY SCOTT PTA
Provider Business Mailing Address
First Line : 1915 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1618
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1915 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1618
Country : US
Telephone Number : 312-674-9132
Fax Number : 312-674-9392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 02/05/2008

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Directions to “ STACEY SCOTT PTA” Practice Location

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