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General NPI Number Information
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NPI Number | 1386785673
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Entity Type | Individual
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Provider Name | MATTHEW CRAIG STAFFORD MPT
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11701 SAN JOSE BLVD STE 210
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City | JACKSONVILLE
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State | FL
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Zip | 32223-0756
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Country | US
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Telephone | 904-858-7450
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Fax | 904-858-7451
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Provider Business Mailing Address
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Address Line | 9745 TOUCHTON RD UNIT 1305
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City | JACKSONVILLE
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State | FL
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Zip | 32246-9201
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Country | US
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Telephone |
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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 | PT 22518
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License Number State | FL
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