Healthcare Provider Details

I. General information

NPI: 1912045576
Provider Name (Legal Business Name): DIANE E STEVENS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

IV. Provider business mailing address

1595 S CALUMET RD STE 3
CHESTERTON IN
46304-2389
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-4888
  • Fax: 219-898-4258
Mailing address:
  • Phone: 219-764-4888
  • Fax: 219-898-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05001122A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: