MEDICARE: MS. STACY LEE EGGEMEYER 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	PT08488	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00306306	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000322387	OTHER	OH	ANTHEM
3	9342356	OTHER	OH	PHCS
4	000000322287	OTHER	OH	ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629076633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY LEE EGGEMEYER PT

Provider Business Mailing Address
First Line	:	560 S LOOP RD
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-3405
Country	:	US
Telephone Number	:	859-301-2663
Fax Number	:	859-817-7848

Provider Business Practice Location Address
First Line	:	4355 FERGUSON DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-5136
Country	:	US
Telephone Number	:	513-221-2663
Fax Number	:	859-817-7848

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	02/02/2021

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Directions to “ MS. STACY LEE EGGEMEYER PT” Practice Location

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