Individual
MS. DIANA FAYE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
8934 W ADELL ST, FORTVILLE, IN 46040-9200
(317) 485-5266
Mailing address
8934 W ADELL ST, FORTVILLE, IN 46040-9200
(317) 485-5266
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05000680A
IN
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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