Healthcare Provider Details

I. General information

NPI: 1386487411
Provider Name (Legal Business Name): BRIANNA LEIGH STEVENS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 W MAIN ST
UNION MO
63084-1084
US

IV. Provider business mailing address

1366 W MAIN ST
UNION MO
63084-1084
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-3344
  • Fax:
Mailing address:
  • Phone: 310-853-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306160
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2024018928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: