Healthcare Provider Details

I. General information

NPI: 1407232101
Provider Name (Legal Business Name): VIRGINIA COBB STEVENS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PLATINUM PT
LAKE MARY FL
32746-4871
US

IV. Provider business mailing address

701 PLATINUM PT
LAKE MARY FL
32746-4871
US

V. Phone/Fax

Practice location:
  • Phone: 407-206-4590
  • Fax: 407-206-4591
Mailing address:
  • Phone: 407-206-4590
  • Fax: 407-206-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 30537
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT30537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: