Provider Demographics
NPI:1235432006
Name:STANTON, DAVID WESLEY (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:STANTON
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-0511
Mailing Address - Country:US
Mailing Address - Phone:405-527-6524
Mailing Address - Fax:405-527-1504
Practice Address - Street 1:1500 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1642
Practice Address - Country:US
Practice Address - Phone:405-527-6524
Practice Address - Fax:405-527-1504
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699900AMedicaid
OK37U158OtherMEDICARE SKILLED FACILITY
OK370158Medicare Oscar/Certification