Healthcare Provider Details

I. General information

NPI: 1295650331
Provider Name (Legal Business Name): CHARLES SETH STANLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HIGHLAND DR
LEBANON VA
24266-4666
US

IV. Provider business mailing address

272 HIGHLAND DR
LEBANON VA
24266-4666
US

V. Phone/Fax

Practice location:
  • Phone: 276-889-4090
  • Fax:
Mailing address:
  • Phone: 276-889-4090
  • Fax: 276-889-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: