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General NPI Number Information
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NPI Number | 1366430951
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Entity Type | Individual
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Provider Name | MARK DAVID STEPHENSON ATC
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Gender | Male
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Dates
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Enumeration Date | 10/08/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1885 BOB JOHNSON DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4000
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Country | US
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Telephone | 719-632-6722
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Fax | 719-632-6367
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Provider Business Mailing Address
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Address Line | 12424 ANGELINA DR
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City | FALCON
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State | CO
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Zip | 80831-8465
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Country | US
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Telephone | 719-495-7328
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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