Healthcare Provider Details

I. General information

NPI: 1457311276
Provider Name (Legal Business Name): DAVID D STANLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 RONALD REAGAN BLVD STE 106
CUMMING GA
30041-7578
US

IV. Provider business mailing address

2400 WISTERIA DR STE A
SNELLVILLE GA
30078-2689
US

V. Phone/Fax

Practice location:
  • Phone: 708-870-5027
  • Fax: 770-887-0054
Mailing address:
  • Phone: 770-982-0102
  • Fax: 770-982-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006706
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number006706
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: