Provider Demographics
NPI:1063441897
Name:BASYE, STACYE L (PT)
Entity type:Individual
Prefix:MS
First Name:STACYE
Middle Name:L
Last Name:BASYE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-792-9737
Mailing Address - Fax:909-793-6978
Practice Address - Street 1:245 TERRACINA BLVD
Practice Address - Street 2:SUITE NUMBER 105
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4852
Practice Address - Country:US
Practice Address - Phone:909-792-9737
Practice Address - Fax:909-793-6978
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33588208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532491OtherBCBS
Q66711Medicare UPIN