Provider Demographics
NPI:1841331030
Name:STAFFORD, CHARLENE EVELYN (PT)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:EVELYN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:8491 W GRAND RIVER AVE STE 600
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4359
Practice Address - Country:US
Practice Address - Phone:810-225-1187
Practice Address - Fax:810-225-1284
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2018-04-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist