Individual
MR. GERALD DWAYNE STAKELY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
162 DEACON WAY, MOCKSVILLE, NC 27028-5183
(336) 480-8368
Mailing address
162 DEACON WAY, MOCKSVILLE, NC 27028-5183
(336) 480-8368
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6516
NC
Other
Enumeration date
06/17/2018
Last updated
06/17/2018
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