Provider Demographics
NPI:1780677112
Name:STAFFORD, ROGER A (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:A
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 BROADCASTING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3220
Mailing Address - Country:US
Mailing Address - Phone:610-685-9600
Mailing Address - Fax:610-685-6700
Practice Address - Street 1:1350 BROADCASTING RD
Practice Address - Street 2:STE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3220
Practice Address - Country:US
Practice Address - Phone:610-685-9600
Practice Address - Fax:610-685-6700
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000227A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer