Provider Demographics
NPI:1922318849
Name:FORD DANIELS, STARLA DEATON (PT, DPT, PCS)
Entity Type:Individual
Prefix:DR
First Name:STARLA
Middle Name:DEATON
Last Name:FORD DANIELS
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 SHELBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4532
Mailing Address - Country:US
Mailing Address - Phone:770-845-8085
Mailing Address - Fax:
Practice Address - Street 1:149 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-377-2230
Practice Address - Fax:585-377-2243
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist