National Provider Identifier
Stacy Lynn Wentworth, PT
Stacy Lynn Wentworth, PT is listed in the NPPES registry with a primary specialty of Physical Therapist in Leroy, NY and a listed phone number of (585) 768-4550.
Profile Overview
- NPI
- 1104908029
- Provider Type
- Individual
- Primary Specialty
- Physical Therapist
- Enumeration Date
- October 19, 2006
- Last Updated
- July 08, 2007
Practice Location
- 3 West Ave
- Leroy, NY 14482
Phone: (585) 768-4550
Mailing Address
- 38 Ridge Meadows Dr
- Spencerport, NY 14559
Specialties
- Physical Therapist (225100000X)
Full Record
- NPI
- 1104908029
- Entity Type
- Individual
- Last Name
- Wentworth
- First Name
- Stacy
- Middle Name
- Lynn
- Name Prefix
- Mrs.
- Credential
- PT
- Provider Other Last Name
- Defazio
- Provider Other First Name
- Stacy
- Provider Other Middle Name
- Lynn
- Provider Other Name Prefix Text
- Miss
- Provider Other Credential Text
- PT
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 38 Ridge Meadows Dr
- Mailing City
- Spencerport
- Mailing State
- NY
- Mailing ZIP Code
- 14559
- Mailing Country
- US
- Mailing Phone
- (585) 349-1455
- Practice Street Address
- 3 West Ave
- Practice City
- Leroy
- Practice State
- NY
- Practice ZIP Code
- 14482
- Practice Country
- US
- Practice Phone
- (585) 768-4550
- Practice Fax
- (585) 768-2335
- Enumeration Date
- October 19, 2006
- Last Updated
- July 08, 2007
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physical Therapist (225100000X)