Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 292 | NE |
NPI | 1356602718 |
---|---|
Provider Name | Stephanie Stevens |
First Address | Polk, NE 68654 |
Second Address | Polk, NE 68654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2012 |
Last Update Date | 01/06/2012 |