Provider Demographics
NPI:1043284060
Name:STANLEY, JEFFREY NIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:NIEL
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 TOWN MOUNTAIN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1632
Mailing Address - Country:US
Mailing Address - Phone:606-432-8782
Mailing Address - Fax:606-432-8858
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 108
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1632
Practice Address - Country:US
Practice Address - Phone:606-432-8782
Practice Address - Fax:606-432-8858
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5007504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000192030OtherANTHEM
WV1068965OtherBRICKSTREET
KY000000192030OtherANTHEM