Healthcare Provider Details

I. General information

NPI: 1609107168
Provider Name (Legal Business Name): DANIELIA MARIE STONER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 S STATE ROAD 145
FRENCH LICK IN
47432-1036
US

IV. Provider business mailing address

9930 W COUNTY ROAD 75 S
FRENCH LICK IN
47432-9516
US

V. Phone/Fax

Practice location:
  • Phone: 812-936-9991
  • Fax:
Mailing address:
  • Phone: 812-936-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002826A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: