Provider Demographics
NPI:1881704567
Name:STACK, NORMAN SHAWN (PTA)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:SHAWN
Last Name:STACK
Suffix:
Gender:M
Credentials:PTA
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Mailing Address - Street 1:10429 FOX GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-4562
Mailing Address - Country:US
Mailing Address - Phone:302-628-3514
Mailing Address - Fax:
Practice Address - Street 1:600 GLEN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5250
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-860-9583
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA2330OtherLICENSE #