Provider Demographics
NPI:1689631632
Name:STANDLEY, DAWN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:256-247-1708
Mailing Address - Fax:256-247-5798
Practice Address - Street 1:16390 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8103
Practice Address - Country:US
Practice Address - Phone:256-247-1708
Practice Address - Fax:256-247-5798
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01853225100000X
ALPTH8745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO483367413Medicaid
MO000025407OtherMEDICARE PTAN