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General NPI Number Information
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NPI Number | 1235385030
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Entity Type | Individual
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Provider Name | MICHAEL DUANE STEPHENS ATC, PTA
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 120 BECKRICH RD SUITE 130
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2521
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Country | US
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Telephone | 850-235-6360
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Fax | 850-235-7781
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Provider Business Mailing Address
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Address Line | 148 TREASURE PALM DR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408-7715
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Country | US
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Telephone | 850-235-6360
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Fax | 850-235-8871
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL1308
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA20905
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License Number State | FL
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