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General NPI Number Information
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NPI Number | 1386464410
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Entity Type | Individual
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Provider Name | VIRGINIA STALNAKER DPT
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Gender | Female
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 470 W BROADWAY STE 2
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City | SOUTH BOSTON
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State | MA
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Zip | 02127-2260
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Country | US
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Telephone | 617-752-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 703 GRANITE ST STE 3
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City | BRAINTREE
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State | MA
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Zip | 02184-5350
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Country | US
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Telephone | 781-807-6138
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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 | PTL27997
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License Number State | MA
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