Healthcare Provider Details

I. General information

NPI: 1992425722
Provider Name (Legal Business Name): MARIA STALDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W SENECA ST STE 12
MANLIUS NY
13104-2422
US

IV. Provider business mailing address

2448 TUCKER RD
NEW WOODSTOCK NY
13122-8607
US

V. Phone/Fax

Practice location:
  • Phone: 315-682-0325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23311
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41244
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number049147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: