Individual
JOHNIE RAY STATON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2091 RIDGEMERE WAY, GREENWOOD, IN 46143-9288
(317) 887-1600
Mailing address
2091 RIDGEMERE WAY, GREENWOOD, IN 46143-9288
(317) 887-1600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05014558A
IN
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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