Provider Demographics
NPI:1972076842
Name:STANIFER, MISTY PAGE (PTA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:PAGE
Last Name:STANIFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 TAZEWELL HWY
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-6042
Mailing Address - Country:US
Mailing Address - Phone:423-300-9157
Mailing Address - Fax:
Practice Address - Street 1:1423 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3654
Practice Address - Country:US
Practice Address - Phone:423-733-4783
Practice Address - Fax:423-733-2944
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4168225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant