Individual
MARK W STATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
715 N BEAVER ST, FLAGSTAFF, AZ 86001
(928) 773-1601
(928) 773-1603
Mailing address
715 N BEAVER ST, FLAGSTAFF, AZ 86001
(928) 773-1601
(928) 773-1603
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
AZ2618
AZ
Other
Enumeration date
06/08/2005
Last updated
03/04/2008
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