Provider Demographics
NPI:1013723634
Name:STANTON, DEJAE' (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEJAE'
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 OLD FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5930 OLD FRENCH RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3656
Practice Address - Country:US
Practice Address - Phone:814-860-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-07-23
Deactivation Date:2024-12-10
Deactivation Code:
Reactivation Date:2025-07-23
Provider Licenses
StateLicense IDTaxonomies
PATPT023900225100000X
PAPT033257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist