MEDICARE: MS. STACEY JOYCE FOOTE 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	2396	AZ

General Provider Information

NPI Number	:	1598063547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACEY JOYCE FOOTE PT

Provider Business Mailing Address
First Line	:	405 W MAIN ST
Second Line	:	STE D
City	:	PAYSON
State	:	AZ
Zip	:	85541-5345
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 W MAIN ST
Second Line	:	STE D
City	:	PAYSON
State	:	AZ
Zip	:	85541-5345
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:

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

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	10/31/2016

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