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General NPI Number Information
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NPI Number | 1417461997
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Entity Type | Individual
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Provider Name | JOSEPH STUTHERS MS, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 5523 WINTER GARDEN VINELAND RD
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City | WINDERMERE
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State | FL
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Zip | 34786-6097
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Country | US
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Telephone | 850-380-7628
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Fax |
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Provider Business Mailing Address
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Address Line | 10418 LOG HOUSE RD
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City | CLERMONT
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State | FL
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Zip | 34711-8450
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Country | US
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Telephone | 850-380-7628
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1824
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4874
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License Number State | FL
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