Provider Demographics
NPI:1528310745
Name:STALEY, DANA (DPT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:STALEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-1018
Mailing Address - Country:US
Mailing Address - Phone:607-753-1886
Mailing Address - Fax:
Practice Address - Street 1:6 LOCUST ST
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-1018
Practice Address - Country:US
Practice Address - Phone:607-753-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030615225100000X
PA021565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030615OtherNY STATE DEPARTMENT OF EDUCATION
PA021565OtherPENNSYLVANIA DEPARTMENT OF EDUCATION