Provider Demographics
NPI:1316376676
Name:HUSTON, STACY (DPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HUSTON
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 1:701 CAMINO DEL RIO STE 221
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5466
Mailing Address - Country:US
Mailing Address - Phone:970-247-3261
Mailing Address - Fax:970-247-8333
Practice Address - Street 1:701 CAMINO DEL RIO STE 221
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5466
Practice Address - Country:US
Practice Address - Phone:970-247-3261
Practice Address - Fax:970-247-8333
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013195225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist