| NPI | 1861824468 |
|---|---|
| Former Name | STACIE THOMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 005205) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2026-07-16 |