Basic Information
| Provider Information | |||||||||
| NPI: | 1881716454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA - IS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4074 THOMPSON RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194441407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108281438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1800879447 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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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 | 225200000X | TEI001015 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.