MEDICARE: MR. ROBERT ALLEN STAUFFER CMMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1558677732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ALLEN STAUFFER CMMT

Provider Business Mailing Address
First Line	:	422 STATE ST
Second Line	:	SUITE B
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3130
Country	:	US
Telephone Number	:	269-470-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 STATE ST
Second Line	:	SUITE B
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3130
Country	:	US
Telephone Number	:	269-470-5678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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