MEDICARE: STACEY L DIONNE 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	1064814	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB104690	OTHER	TX	MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598798175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L DIONNE PT

Provider Business Mailing Address
First Line	:	5100 W. ELDORADO PKWY #102-20FC
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75072
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

Provider Business Practice Location Address
First Line	:	5000 WESTERN CENTER BLVD
Second Line	:	STE 220
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/24/2019

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Directions to “ STACEY L DIONNE PT” Practice Location

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