Provider Demographics
NPI:1851712780
Name:STAVLO, JOSEPH JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:STAVLO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 DELRIDGE WAY SW
Mailing Address - Street 2:APT 1C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3476
Mailing Address - Country:US
Mailing Address - Phone:206-743-7527
Mailing Address - Fax:
Practice Address - Street 1:7701 DELRIDGE WAY SW
Practice Address - Street 2:APT 1C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-3476
Practice Address - Country:US
Practice Address - Phone:206-743-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60231782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant