Healthcare Provider Details

I. General information

NPI: 1205998630
Provider Name (Legal Business Name): CRYSTAL STEVENS LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL STEVENS LPT

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 STONESTREET RD SUITE 400
LOUISVILLE KY
40272-2876
US

IV. Provider business mailing address

9300 STONESTREET RD SUITE 400
LOUISVILLE KY
40272-2876
US

V. Phone/Fax

Practice location:
  • Phone: 502-935-9776
  • Fax: 502-935-9813
Mailing address:
  • Phone: 502-935-9776
  • Fax: 502-935-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number004317
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: