Provider Demographics
NPI:1730700329
Name:MILLAR, STACY ANNE (DPT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANNE
Last Name:MILLAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANNE
Other - Last Name:AKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 LAUREL CYN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4489
Mailing Address - Country:US
Mailing Address - Phone:423-262-9445
Mailing Address - Fax:
Practice Address - Street 1:102 LAUREL CYN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4489
Practice Address - Country:US
Practice Address - Phone:423-262-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000008273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist