Provider Demographics
NPI:1215240122
Name:LEMKE, STACY JEAN (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JEAN
Last Name:LEMKE
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 1:1106 VALE ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2327
Mailing Address - Country:US
Mailing Address - Phone:520-720-7232
Mailing Address - Fax:
Practice Address - Street 1:1106 VALE ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2327
Practice Address - Country:US
Practice Address - Phone:520-720-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7255PT225100000X
CA34893225100000X
FLPT249600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist