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NPI Code Detail

MEDICARE: STACEY M PLACE PT

MEDICARE: STACEY M PLACE 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
1225100000XPhysical Therapist6392-024WI

General Provider Information

NPI Number : 1831200823
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY M PLACE PT
Provider Business Mailing Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Provider Business Practice Location Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 02/18/2026

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