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NPI Code Detail

MEDICARE: TIMOTHY STEVENSON DPT

MEDICARE: TIMOTHY STEVENSON DPT
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
1225100000XPhysical Therapist544AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1544OTHERAKSTATE LICENSE

General Provider Information

NPI Number : 1083035604
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY STEVENSON DPT
Provider Business Mailing Address
First Line : 157 LEWIS ST
Second Line :
City : NORTH POLE
State : AK
Zip : 99705-7699
Country : US
Telephone Number : 907-488-4978
Fax Number : 907-488-4976
Provider Business Practice Location Address
First Line : 157 LEWIS ST
Second Line :
City : NORTH POLE
State : AK
Zip : 99705-7699
Country : US
Telephone Number : 907-488-4978
Fax Number : 907-488-4976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2013
Last Update Date : 12/27/2013

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