Healthcare Provider Details

I. General information

NPI: 1689631632
Provider Name (Legal Business Name): DAWN M STANDLEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16390 HIGHWAY 72
ROGERSVILLE AL
35652-8103
US

IV. Provider business mailing address

199 N BROOKMOORE DR
COLUMBUS MS
39705-2024
US

V. Phone/Fax

Practice location:
  • Phone: 256-247-1708
  • Fax: 256-247-5798
Mailing address:
  • Phone: 256-247-1708
  • Fax: 256-247-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01853
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8745
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: