Provider Demographics
NPI:1730512930
Name:STAFFORD, KACI LYNN (DPT)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:LYNN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:2960 ELDORADO PKWY
Practice Address - Street 2:SUITE 75
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4373
Practice Address - Country:US
Practice Address - Phone:972-562-0713
Practice Address - Fax:972-562-0932
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1234612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX471544ZS1MMedicare PIN
TX470447Medicare PIN