Provider Demographics
NPI:1902583362
Name:NEUSCHAEFER, STACY LYN (PT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYN
Last Name:NEUSCHAEFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:JORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 E VILLAGE GREEN CIR STE C
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5500
Mailing Address - Country:US
Mailing Address - Phone:801-440-5592
Mailing Address - Fax:801-206-3059
Practice Address - Street 1:5909 NW EXPRESSWAY STE 229
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5161
Practice Address - Country:US
Practice Address - Phone:801-440-5592
Practice Address - Fax:801-206-3059
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist