Provider Demographics
NPI:1568689297
Name:DAY, STANLEY CHESTER III (PT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:CHESTER
Last Name:DAY
Suffix:III
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 1:12839 FOLLY QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1273
Mailing Address - Country:US
Mailing Address - Phone:410-925-2477
Mailing Address - Fax:410-531-6806
Practice Address - Street 1:12839 FOLLY QUARTER RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1273
Practice Address - Country:US
Practice Address - Phone:410-925-2477
Practice Address - Fax:410-531-6806
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ163Medicare ID - Type Unspecified