Provider Demographics
NPI:1841675832
Name:GIVENS, STANFORD B JR (DPT)
Entity type:Individual
Prefix:MR
First Name:STANFORD
Middle Name:B
Last Name:GIVENS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9785
Mailing Address - Country:US
Mailing Address - Phone:904-669-8427
Mailing Address - Fax:
Practice Address - Street 1:3601 38TH AVE S
Practice Address - Street 2:COMPANY C, 53RD BSB
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4329
Practice Address - Country:US
Practice Address - Phone:727-893-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist