Provider Demographics
NPI:1427289214
Name:MEAD, STACI RENEE (MPT)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:RENEE
Last Name:MEAD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 VERSAILLES SOUTHEASTERN RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45308-9602
Mailing Address - Country:US
Mailing Address - Phone:513-227-0174
Mailing Address - Fax:
Practice Address - Street 1:8190 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6117
Practice Address - Country:US
Practice Address - Phone:513-474-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist