Individual
MR. ETHAN STANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
4600 BRAMBLETON AVE, STE B, ROANOKE, VA 24018-3437
(540) 774-0729
Mailing address
4600 BRAMBLETON AVE, STE B, ROANOKE, VA 24018-3437
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207746
VA
225100000X
Physical Therapist
P14016
NC
Other
Enumeration date
11/26/2012
Last updated
11/30/2016
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