Provider Demographics
NPI:1730127085
Name:STANAWAY, IAN NOBLE (MPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:NOBLE
Last Name:STANAWAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 MOUNTAIN VIEW RD
Mailing Address - Street 2:STE. 115
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6668
Mailing Address - Country:US
Mailing Address - Phone:142-323-8112
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:6711 MOUNTAIN VIEW RD
Practice Address - Street 2:STE. 115
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6668
Practice Address - Country:US
Practice Address - Phone:142-323-8112
Practice Address - Fax:423-238-1277
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441377Medicaid