Provider Demographics
NPI:1548409527
Name:STANLEY, DENISE M (PTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 TANNER DR
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1810
Mailing Address - Country:US
Mailing Address - Phone:805-238-5881
Mailing Address - Fax:
Practice Address - Street 1:1191 CRESTON RD STE 115
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3033
Practice Address - Country:US
Practice Address - Phone:805-239-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 774208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation