Provider Demographics
NPI:1245704006
Name:STAUDINGER, TALON JACOB (ATS)
Entity type:Individual
Prefix:
First Name:TALON
Middle Name:JACOB
Last Name:STAUDINGER
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 DENALI PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6872
Mailing Address - Country:US
Mailing Address - Phone:701-590-3304
Mailing Address - Fax:
Practice Address - Street 1:4411 DENALI PL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6872
Practice Address - Country:US
Practice Address - Phone:701-590-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist