Provider Demographics
NPI:1265858187
Name:STANFORD, JANET (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:T
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:100 E FERGUSON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5759
Mailing Address - Country:US
Mailing Address - Phone:903-509-2040
Mailing Address - Fax:
Practice Address - Street 1:100 E FERGUSON ST
Practice Address - Street 2:SUITE 1204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5759
Practice Address - Country:US
Practice Address - Phone:903-509-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist