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General NPI Number Information
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NPI Number | 1124836218
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Entity Type | Individual
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Provider Name | SAMUEL DALE STEVENS DPT
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Gender | Male
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 6450 S BOSTON ST
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5336
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Country | US
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Telephone | 303-224-9455
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Fax |
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Provider Business Mailing Address
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Address Line | 21835 E IDYLLWILDE DR
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City | PARKER
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State | CO
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Zip | 80138-8887
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Country | US
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Telephone | 720-635-0886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | XP1254139
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License Number State | NC
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