Healthcare Provider Details

I. General information

NPI: 1528005246
Provider Name (Legal Business Name): RICHARD LEHMAN STILES JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 HARLEYSVILLE PIKE RT 113
LEDERACH PA
19454-0396
US

IV. Provider business mailing address

P O BOX 396
LEDERACH PA
19454-0396
US

V. Phone/Fax

Practice location:
  • Phone: 215-256-1991
  • Fax: 215-256-1895
Mailing address:
  • Phone: 215-256-1991
  • Fax: 215-256-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006436L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5012004
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA US HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: