Provider Demographics
NPI:1215586235
Name:GRABOWSKI, STACY (DPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57825 716TH RD
Mailing Address - Street 2:
Mailing Address - City:JANSEN
Mailing Address - State:NE
Mailing Address - Zip Code:68377-4066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3219
Practice Address - Country:US
Practice Address - Phone:308-536-3244
Practice Address - Fax:308-536-3277
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06234225100000X
NE4094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist