MEDICARE: MS. MICHELE LANATTE STEVENS LPTA

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
1	225200000X	Physical Therapy Assistant	2006193	TX

General Provider Information

NPI Number	:	1467280511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE LANATTE STEVENS LPTA

Provider Business Mailing Address
First Line	:	15835 MILLER RD
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-9606
Country	:	US
Telephone Number	:	210-872-2664
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SCHOFIELD RD
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7577
Country	:	US
Telephone Number	:	210-808-2226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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