Provider Demographics
NPI:1124120704
Name:STATON, JUANITA LEANN (PT)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:LEANN
Last Name:STATON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 ENTERPRISE WAY NW STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4472
Mailing Address - Country:US
Mailing Address - Phone:256-713-1872
Mailing Address - Fax:256-713-1873
Practice Address - Street 1:1267 ENTERPRISE WAY NW STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4472
Practice Address - Country:US
Practice Address - Phone:256-713-1872
Practice Address - Fax:256-713-1873
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4184225100000X
ALPTH4831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH4831OtherPHYSICAL THERAPIST LICENS
MSPT4184OtherMISSSISSIPPI STATE BOARD OF PHYSICAL THERAPY