=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114127180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA KAY STANLEY PHYSICAL THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2007
-----------------------------------------------------
Last Update Date | 07/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 COLLINS DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-4826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-373-5010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3662
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-6662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-425-9391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 3374
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------