Provider Demographics
NPI:1427780709
Name:STASIS LLC
Entity type:Organization
Organization Name:STASIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:317-854-6780
Mailing Address - Street 1:5401 SAFE HARBOUR WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1796
Mailing Address - Country:US
Mailing Address - Phone:727-798-7144
Mailing Address - Fax:
Practice Address - Street 1:39 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1545
Practice Address - Country:US
Practice Address - Phone:317-854-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty