Revak, Stacey M
Revak, Stacey M is an individual health care provider with primary practice located at 3335 Darbyshire Dr , Canfield OH 44406-9232. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Revak, Stacey M can be contacted via phone (330) 793-7234.Contact Information
Primary practice address
3335 Darbyshire Dr
Canfield OH 44406-9232
Phone: (330) 793-7234
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 10883 | Ohio |
Profile Details
| NPI number | 1215918453 |
|---|---|
| LBN Legal business name | Revak, Stacey M |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 5th, 2005 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215918453 | NPPES |
| Ohio | Other | P00214958 | MEDICARE RAILROAD |
| Ohio | MEDICAID | 2523504 | MEDICARE RAILROAD |
| Ohio | Other | 000000344719 | MEDICARE RAILROAD |
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