Provider Demographics
NPI:1265720239
Name:BOWERS, STACY ANN (DPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:41818 N VENTURE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3188
Mailing Address - Country:US
Mailing Address - Phone:623-742-7338
Mailing Address - Fax:623-742-7339
Practice Address - Street 1:41818 N VENTURE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3188
Practice Address - Country:US
Practice Address - Phone:623-742-7338
Practice Address - Fax:623-742-7339
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23721225100000X
PAPT021003225100000X
AZ10957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ951476Medicaid
AZZ172477Medicare PIN