Provider Demographics
NPI:1962154625
Name:STANTON, NICHOLAS J (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:STANTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 GADSDEN HWY # 104-108
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2640
Mailing Address - Country:US
Mailing Address - Phone:659-444-1193
Mailing Address - Fax:
Practice Address - Street 1:7270 GADSDEN HWY # 104-108
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2640
Practice Address - Country:US
Practice Address - Phone:659-444-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-1084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist