Provider Demographics
NPI:1871806422
Name:STANCIK, CAMILLE (DPT)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:STANCIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-1475
Mailing Address - Country:US
Mailing Address - Phone:979-542-7300
Mailing Address - Fax:979-542-7373
Practice Address - Street 1:283 E RAILROAD ROW
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-2639
Practice Address - Country:US
Practice Address - Phone:979-542-7300
Practice Address - Fax:979-542-7373
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1198638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist