Provider Demographics
NPI:1730247768
Name:PARSONS, STACEY MACY (DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MACY
Last Name:PARSONS
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:MACY
Other - Last Name:SIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, OCS
Mailing Address - Street 1:1800 S PACIFIC COAST HWY UNIT 9
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6165
Mailing Address - Country:US
Mailing Address - Phone:510-579-3969
Mailing Address - Fax:
Practice Address - Street 1:1612 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5214
Practice Address - Country:US
Practice Address - Phone:424-290-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27591AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST