Healthcare Provider Details

I. General information

NPI: 1558677732
Provider Name (Legal Business Name): ROBERT ALLEN STAUFFER CMMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 STATE ST SUITE B
SAINT JOSEPH MI
49085-3130
US

IV. Provider business mailing address

422 STATE ST SUITE B
SAINT JOSEPH MI
49085-3130
US

V. Phone/Fax

Practice location:
  • Phone: 269-470-5678
  • Fax:
Mailing address:
  • Phone: 269-470-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: