Provider Demographics
NPI:1588998553
Name:JARAMILLO, STACY LAURELYN (PT, DPT, COMT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LAURELYN
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LAURELYN
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:623 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2956
Mailing Address - Country:US
Mailing Address - Phone:509-209-9488
Mailing Address - Fax:509-209-9489
Practice Address - Street 1:623 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2956
Practice Address - Country:US
Practice Address - Phone:509-209-9488
Practice Address - Fax:509-209-9489
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60194054225100000X, 225100000X
IDPT-29442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic