Provider Demographics
NPI:1912146143
Name:STANLEY, WILLIAM D (DPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:STANLEY
Suffix:
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 1:1236 FOUNTAIN LN
Mailing Address - Street 2:APT. E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3232
Mailing Address - Country:US
Mailing Address - Phone:216-299-1130
Mailing Address - Fax:
Practice Address - Street 1:720 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3988
Practice Address - Country:US
Practice Address - Phone:614-224-1090
Practice Address - Fax:614-224-2042
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003200849Medicaid
OH2003200849Medicaid
OH2003200849Medicare Oscar/Certification
OH2003200849Medicare UPIN
OH2003200849Medicare PIN