1033268180 NPI number — MRS. STASIA LYNN TAPLEY P.T.

Table of content: MRS. STASIA LYNN TAPLEY P.T. (NPI 1033268180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033268180 NPI number — MRS. STASIA LYNN TAPLEY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAPLEY
Provider First Name:
STASIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOODHART
Provider Other First Name:
STASIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033268180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2685 PELHAM PARKWAY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-621-6503
Provider Business Mailing Address Fax Number:
205-621-6507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2685 PELHAM PARKWAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-621-6503
Provider Business Practice Location Address Fax Number:
205-621-6507
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1643 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51535336 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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