Provider Demographics
NPI:1356726640
Name:FILLER, STAN JR
Entity type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:FILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ERLER ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7336
Mailing Address - Country:US
Mailing Address - Phone:907-747-8502
Mailing Address - Fax:907-747-8503
Practice Address - Street 1:310 ERLER ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7336
Practice Address - Country:US
Practice Address - Phone:907-747-8502
Practice Address - Fax:907-747-8503
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist