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NPI Code Detail

MEDICARE: DR. STACY RAE HOLECHEK DPT

MEDICARE: DR. STACY RAE HOLECHEK DPT
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
12251P0200XPediatric Physical Therapist35233CA

General Provider Information

NPI Number : 1871739235
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY RAE HOLECHEK DPT
Provider Business Mailing Address
First Line : 3638 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-5702
Country : US
Telephone Number : 310-204-8999
Fax Number :
Provider Business Practice Location Address
First Line : 3638 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-5702
Country : US
Telephone Number : 310-204-8999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2009
Last Update Date : 01/06/2009

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Directions to “ DR. STACY RAE HOLECHEK DPT” Practice Location

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