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General NPI Number Information
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NPI Number | 1295500411
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Entity Type | Individual
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Provider Name | STACY ANN DANFORTH
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Gender | Female
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 4950 SR 16
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City | ST. AUGUSTINE
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State | FL
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Zip | 32092
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Country | US
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Telephone | 904-901-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 167 STEWART ST
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-0613
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Country | US
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Telephone | 904-460-3396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA26275
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License Number State | FL
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