Provider Demographics
NPI:1588780266
Name:HIGHLEY, STACIA RENEE (PT)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:RENEE
Last Name:HIGHLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-7007
Mailing Address - Country:US
Mailing Address - Phone:304-904-5186
Mailing Address - Fax:
Practice Address - Street 1:2107 PIKE ST STE 10
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6978
Practice Address - Country:US
Practice Address - Phone:304-904-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist