Provider Demographics
NPI:1528107034
Name:FRIEBUS, STACY LYNN (MPT)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:FRIEBUS
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 1:161 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-4084
Mailing Address - Country:US
Mailing Address - Phone:847-841-1778
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVERSIDE PLZ
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5808
Practice Address - Country:US
Practice Address - Phone:312-416-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70012980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist