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NPI Code Detail

MEDICARE: MRS. SUSAN MARIE STEVENS PTA

MEDICARE: MRS. SUSAN MARIE STEVENS PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant000115IA

General Provider Information

NPI Number : 1053307116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN MARIE STEVENS PTA
Provider Business Mailing Address
First Line : PO BOX 1107
Second Line :
City : CEDAR FALLS
State : IA
Zip : 50613-0049
Country : US
Telephone Number : 319-277-3166
Fax Number :
Provider Business Practice Location Address
First Line : 211 W 6TH ST
Second Line :
City : CEDAR FALLS
State : IA
Zip : 50613-2859
Country : US
Telephone Number : 319-277-3166
Fax Number : 319-266-4846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/08/2007

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