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General NPI Number Information
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NPI Number | 1265103154
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Entity Type | Organization
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Legal Business Name | FRAY & STAFFORD PHYSICAL THERAPY, CO
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 3204 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-5667
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Country | US
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Telephone | 321-458-1255
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Fax | 321-339-1929
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Provider Business Mailing Address
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Address Line | 3204 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-5667
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Country | US
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Telephone | 321-458-1255
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Fax | 321-339-1929
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Authorized Official
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Title or Position | CEO
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Name | NATHAN STAFFORD
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Credential | DPT
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Telephone | 321-458-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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