Most Relevant Information
Provider Data
| NPI Number: | 1003428806 |
| Provider Name: | STACI A BURRIS PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 160005049 |
Most Important Dates
| Enumeration Date: | 08/21/2020 |
| Last Updated: | 08/21/2020 |
Provider Practice Location
900 CENTENNIAL DR # 30
EAST PEORIA
IL
616114928
Practice Location Phone/Fax
| Phone: | 3096995400 |
| Fax: |
Provider Mailing Location
1141 N NANCY ST
EAST PEORIA
IL
616119554
Provider Mailing Phone/Fax
| Phone: | 3092519707 |
| Fax: |