Provider Demographics
NPI:1699581538
Name:FORT-STAN LLC
Entity type:Organization
Organization Name:FORT-STAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:814-602-8771
Mailing Address - Street 1:1920 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4935
Mailing Address - Country:US
Mailing Address - Phone:814-456-1097
Mailing Address - Fax:814-287-9375
Practice Address - Street 1:1920 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4935
Practice Address - Country:US
Practice Address - Phone:814-456-1097
Practice Address - Fax:814-287-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty