Provider Demographics
NPI:1689815151
Name:STANLEY, SAMUEL CARSON (CMTPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CARSON
Last Name:STANLEY
Suffix:
Gender:M
Credentials:CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 FORBES AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1646
Mailing Address - Country:US
Mailing Address - Phone:412-580-8708
Mailing Address - Fax:
Practice Address - Street 1:5824 FORBES AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1646
Practice Address - Country:US
Practice Address - Phone:412-580-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist