Provider Demographics
NPI:1417002940
Name:BINGHAM, STANLEY ARDEL (PT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ARDEL
Last Name:BINGHAM
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 1:9458 CHAVEZ DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9282
Mailing Address - Country:US
Mailing Address - Phone:801-253-0262
Mailing Address - Fax:801-274-0947
Practice Address - Street 1:2040 MURRAY HOLLADAY RD
Practice Address - Street 2:205
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-274-0299
Practice Address - Fax:801-274-0947
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119490-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist