Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-011079 | GA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT-011079 | GA |
N | 2251N0400X | Physical Therapist - Neurology | PT-011079 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT-011079 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-011079 | GA |
NPI | 1235561283 |
---|---|
Provider Name | Dr. Meredith L Stevens |
First Address | Cumming, GA 30041-4032 |
Second Address | Cumming, GA 30041-4032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2013 |
Last Update Date | 27/09/2016 |