Provider Demographics
NPI:1417461997
Name:STUTHERS, JOSEPH (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:STUTHERS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 LOG HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8450
Mailing Address - Country:US
Mailing Address - Phone:850-380-7628
Mailing Address - Fax:
Practice Address - Street 1:5523 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6097
Practice Address - Country:US
Practice Address - Phone:850-380-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18242255A2300X
FLAL48742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer