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General NPI Number Information
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NPI Number | 1295611283
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Entity Type | Individual
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Provider Name | JUSTIN STAFFORD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1430 CORPORATE PARKWAY BLVD
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City | CLARKSVILLE
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State | TN
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Zip | 37040-6196
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Country | US
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Telephone | 931-245-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 539 LAKEVIEW DR
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1247
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Country | US
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Telephone | 856-725-3634
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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