Healthcare Provider Details

I. General information

NPI: 1164346326
Provider Name (Legal Business Name): WILLIAM ROBERT ANDERSON STAVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 N NC HIGHWAY 62
BURLINGTON NC
27217-7769
US

IV. Provider business mailing address

6114 N NC HIGHWAY 62
BURLINGTON NC
27217-7769
US

V. Phone/Fax

Practice location:
  • Phone: 336-988-0169
  • Fax:
Mailing address:
  • Phone: 336-988-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23438
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: