Provider Demographics
NPI:1669717641
Name:BRETTHAUER, STACIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:
Last Name:BRETTHAUER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8 SQUANTZ VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2434
Mailing Address - Country:US
Mailing Address - Phone:410-409-3464
Mailing Address - Fax:
Practice Address - Street 1:1 GLEN HILL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4921
Practice Address - Country:US
Practice Address - Phone:203-744-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist