Provider Demographics
NPI:1558677732
Name:STAUFFER, ROBERT ALLEN (CMMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3130
Mailing Address - Country:US
Mailing Address - Phone:269-470-5678
Mailing Address - Fax:
Practice Address - Street 1:422 STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3130
Practice Address - Country:US
Practice Address - Phone:269-470-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist