MEDICARE: JAMES P STANFORD P.T., D.P.T.

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	2251X0800X	Orthopedic Physical Therapist	PT26941	CA

General Provider Information

NPI Number	:	1710943832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES P STANFORD P.T., D.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 1928
Second Line	:
City	:	BLUE JAY
State	:	CA
Zip	:	92317-1928
Country	:	US
Telephone Number	:	909-866-6202
Fax Number	:	909-866-6203

Provider Business Practice Location Address
First Line	:	42007 FOX FARM RD.
Second Line	:	SUITE #2
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315
Country	:	US
Telephone Number	:	909-866-6202
Fax Number	:	909-866-6203

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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