Healthcare Provider Details

I. General information

NPI: 1700591757
Provider Name (Legal Business Name): COLIN R STEVENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319A SOUTHBRIDGE ST
AUBURN MA
01501-2598
US

IV. Provider business mailing address

1124 IRIS DR
MOUNTAINSIDE NJ
07092-2210
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-2628
  • Fax:
Mailing address:
  • Phone: 908-361-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27435
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02143700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: