Provider Demographics
NPI:1871557702
Name:TRICE, STACY M (MPT, ATC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:TRICE
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4802
Mailing Address - Country:US
Mailing Address - Phone:302-677-0100
Mailing Address - Fax:302-677-0267
Practice Address - Street 1:1812 MARSH RD
Practice Address - Street 2:STORE 505
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4581
Practice Address - Country:US
Practice Address - Phone:302-793-0432
Practice Address - Fax:302-793-0400
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001870225100000X, 2251G0304X, 2251S0007X, 2251X0800X
DEJ3-00001712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00284460OtherRAILROAD MEDICARE
DE2623564000OtherAMERIHEALTH
DE015226B93Medicare ID - Type Unspecified
DEQ27886Medicare UPIN
DE2623564000OtherAMERIHEALTH