Provider Demographics
NPI:1558571992
Name:STAPLES, DORETHA (RKT)
Entity Type:Individual
Prefix:MRS
First Name:DORETHA
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 INA CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-0914
Mailing Address - Country:US
Mailing Address - Phone:901-384-4472
Mailing Address - Fax:
Practice Address - Street 1:9216 INA CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-0914
Practice Address - Country:US
Practice Address - Phone:901-384-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1086226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist