| Doctor Name: | MARY S STANFORD |
| NPI Number: | 1396701355 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T., O.C.S. |
| License Number: | PT19301 |
| Business Practice Address: | 42007 Fox Farm Rd. Suite #2 Big Bear Lake, CA - 92315 |
| Business Phone Number: | 9098666202 |
| Business Fax Number: | 9098666203 |
| Mailing Address: | Po Box 1928, BLUE JAY |
| State: | CA |
| Postal Code: | 923171928 |
| Phone Number: | 9098666202 |
| Fax Number: | 9098666203 |
| NPI Enumeration Date: | 04/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251E1200X |
| License Number: | PT19301 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Ergonomics |
| Taxonomy Definition: | |