Provider Demographics
NPI:1700431145
Name:CHRISTMAN, STACY DONNIA (CERTIFIED PEDORTHIST)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:DONNIA
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:DONNIA
Other - Last Name:CHRISTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED PEDORTHIST
Mailing Address - Street 1:2007 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4802
Mailing Address - Country:US
Mailing Address - Phone:972-746-0987
Mailing Address - Fax:
Practice Address - Street 1:1106 ALSTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4644
Practice Address - Country:US
Practice Address - Phone:817-335-1445
Practice Address - Fax:817-336-1171
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED4496224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty