Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306602993 | VA |
N | 225200000X | Physical Therapy Assistant | PTA 20180 | FL |
NPI | 1013033729 |
---|---|
Provider Name | Stephanie Stevens |
First Address | Glen Allen, VA 23059-7555 |
Second Address | Richmond, VA 23233-7017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 07/10/2014 |