Provider Demographics
NPI:1023063773
Name:STAGGERS, JOHN W III (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:STAGGERS
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N SHERIDAN LANE
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726
Mailing Address - Country:US
Mailing Address - Phone:304-813-7839
Mailing Address - Fax:
Practice Address - Street 1:160 N SHERIDAN LANE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-813-7839
Practice Address - Fax:304-822-4977
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001354225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006OtherCAREFIRST BCBS OF DC NCA
WV0157287000Medicaid
225928OtherMAMSI
MD53386804OtherBLUECROSS BLUESHIELD
650016655OtherRAILROAD MEDICARE
7178361OtherAETNA
WV1017320OtherWORKERS COMPENSATION