Provider Demographics
NPI:1861697922
Name:BROWN, STACEE LEE (PT, DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:STACEE
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:MISS
Other - First Name:STACEE
Other - Middle Name:LEE
Other - Last Name:DEWYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:2185 BUSH ST
Mailing Address - Street 2:APT. 308
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5202
Mailing Address - Country:US
Mailing Address - Phone:415-297-4113
Mailing Address - Fax:
Practice Address - Street 1:2356 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2715
Practice Address - Country:US
Practice Address - Phone:415-297-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist