Provider Demographics
NPI:1780202614
Name:STANNARD, DYLAN JAMES (DPT)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:STANNARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:J
Other - Last Name:STANNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:181 HAWTHORNE AVE LOWR APT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-3015
Mailing Address - Country:US
Mailing Address - Phone:315-751-6436
Mailing Address - Fax:
Practice Address - Street 1:5544 MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5406
Practice Address - Country:US
Practice Address - Phone:716-580-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY050091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist