Provider Demographics
NPI:1316427180
Name:KREIMAN, STACY (PTA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KREIMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 RUTSON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3934
Mailing Address - Country:US
Mailing Address - Phone:806-341-1372
Mailing Address - Fax:
Practice Address - Street 1:1910 MEDI PARK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2187
Practice Address - Country:US
Practice Address - Phone:806-457-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherMANAGED CARE