Basic Information
| Provider Information | |||||||||
| NPI: | 1699146605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANCIL | ||||||||
| FirstName: | PATTY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BURTZ | ||||||||
| OtherFirstName: | PATTY | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2400 WISTERIA DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300782689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709820102 | ||||||||
| FaxNumber: | 7709820130 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 LIMESTONE PKWY | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305012013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705369300 | ||||||||
| FaxNumber: | 7705369389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2015 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT007825 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.