Provider Demographics
NPI:1871034561
Name:GARRETT, STACEY (MPT)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7568
Mailing Address - Fax:
Practice Address - Street 1:455 GREENWOOD PARK SOUTH DR STE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4570
Practice Address - Country:US
Practice Address - Phone:317-440-8962
Practice Address - Fax:317-536-3730
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0500594A225100000X
TN12949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist