Provider Demographics
NPI:1366115024
Name:STACY, DREW (DPT)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:STACY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 SAMPSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669-4628
Mailing Address - Country:US
Mailing Address - Phone:337-513-4665
Mailing Address - Fax:337-806-8347
Practice Address - Street 1:1306 SAMPSON ST STE B
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669-4628
Practice Address - Country:US
Practice Address - Phone:337-513-4665
Practice Address - Fax:337-806-8347
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03802225100000X
LA08202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist