Provider Demographics
NPI:1710943832
Name:STANFORD, JAMES P (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:STANFORD
Suffix:
Gender:M
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:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-1928
Mailing Address - Country:US
Mailing Address - Phone:909-866-6202
Mailing Address - Fax:909-866-6203
Practice Address - Street 1:42007 FOX FARM RD.
Practice Address - Street 2:SUITE #2
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-866-6202
Practice Address - Fax:909-866-6203
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT269412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT269411Medicare ID - Type UnspecifiedP.T. PROVIDER NUMBER