Provider Demographics
NPI:1457313603
Name:STAFFORD, DEBORAH F (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:F
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:J
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9172
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:903 W MARTIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-0903
Practice Address - Country:US
Practice Address - Phone:210-358-3144
Practice Address - Fax:210-358-5944
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7184768OtherAETNA
Q51072Medicare UPIN
VA010187117Medicaid
VA010187117Medicaid