Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | PT19301 | CA |
N | 225XE1200X | Ergonomics | PT19301 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT19301 | CA |
NPI | 1396701355 |
---|---|
Provider Name | Mary S Stanford |
First Address | Blue Jay, CA 92317-1928 |
Second Address | Big Bear Lake, CA 92315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |