Provider Demographics
NPI:1982976734
Name:HARR, STACI (PT)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:HARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:CAUDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1068 MORRIS LANE BLUE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8039
Mailing Address - Country:US
Mailing Address - Phone:740-285-4277
Mailing Address - Fax:
Practice Address - Street 1:2125 ROYCE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4714
Practice Address - Country:US
Practice Address - Phone:740-354-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052352251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics