Provider Demographics
NPI:1104805985
Name:STANDFORD, VIRGINIA MARIE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:STANDFORD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 GRAPE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8808
Mailing Address - Country:US
Mailing Address - Phone:301-845-7289
Mailing Address - Fax:240-215-9026
Practice Address - Street 1:610 SOLAREX CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8624
Practice Address - Country:US
Practice Address - Phone:240-215-9023
Practice Address - Fax:240-215-9026
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK1340002OtherCAP/FED BC
MD602030700OtherDEPT OF LABOR MSS
MDR5590003OtherFSS CAP BC
MD147719000OtherDEPT OF LABOR
MD546240-06OtherCAREFIRST FSS
MD54624007OtherMSS BC
MD034NK475Medicare ID - Type UnspecifiedMSS MC
MDK1340002OtherCAP/FED BC
MD602030700OtherDEPT OF LABOR MSS
MD650022014Medicare ID - Type UnspecifiedMC RAILROAD