Provider Demographics
NPI:1588739312
Name:HOWELL, STACEY WILLIAMS (PTA, ATC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:WILLIAMS
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ISLAND PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:843-284-5285
Mailing Address - Fax:
Practice Address - Street 1:900 ISLAND PARK DR
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7559
Practice Address - Country:US
Practice Address - Phone:843-284-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3092255A2300X
SC1403225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer