Provider Demographics
NPI:1215961552
Name:GANDIA, STACY (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GANDIA
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 1:28 WELLSPRING DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1358
Mailing Address - Country:US
Mailing Address - Phone:302-453-1588
Mailing Address - Fax:
Practice Address - Street 1:1501 CASHO MILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-3500
Practice Address - Country:US
Practice Address - Phone:302-453-1588
Practice Address - Fax:302-453-9705
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist