Healthcare Provider Details

I. General information

NPI: 1285603134
Provider Name (Legal Business Name): LAURA M. STEVENS PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

IV. Provider business mailing address

PO BOX 729 583 ROUTE 32
HIGHLAND MILLS NY
10930-0729
US

V. Phone/Fax

Practice location:
  • Phone: 845-928-2426
  • Fax: 845-928-8182
Mailing address:
  • Phone: 845-928-2426
  • Fax: 845-928-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009394-1
License Number StateNY

VIII. Authorized Official

Name: LAURA M STEVENS
Title or Position: PRESIDENT
Credential: PT
Phone: 845-928-2426