MEDICARE: CAMILLE STANCIK 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
1	225100000X	Physical Therapist	1198638	TX

General Provider Information

NPI Number	:	1871806422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE STANCIK DPT

Provider Business Mailing Address
First Line	:	PO BOX 1615
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-1475
Country	:	US
Telephone Number	:	979-542-7300
Fax Number	:	979-542-7373

Provider Business Practice Location Address
First Line	:	283 E RAILROAD ROW
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-2639
Country	:	US
Telephone Number	:	979-542-7300
Fax Number	:	979-542-7373

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

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	07/23/2010

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