Provider Demographics
NPI:1659596245
Name:STANLEY, NANCY W (DPT)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:W
Last Name:STANLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 COOGAN WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7059
Mailing Address - Country:US
Mailing Address - Phone:912-537-0818
Mailing Address - Fax:
Practice Address - Street 1:924 COOGAN WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7059
Practice Address - Country:US
Practice Address - Phone:912-537-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist