Basic Information
| Provider Information | |||||||||
| NPI: | 1730428210 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TORRESCANO | ||||||||
| FirstName: | STACEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 PHILLIPS RD | ||||||||
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| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085304 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1650 PHILLIPS RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502163017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2013 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA15908 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.