Provider Demographics
NPI:1336378108
Name:SCHIAVONE, STACY LYNN (DPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SCHIAVONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:GIRARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:100 WHEATFIELD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7698
Mailing Address - Country:US
Mailing Address - Phone:570-296-5911
Mailing Address - Fax:570-296-5931
Practice Address - Street 1:100 WHEATFIELD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7698
Practice Address - Country:US
Practice Address - Phone:570-296-5911
Practice Address - Fax:570-296-5931
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167126R9XMedicare Oscar/Certification