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General NPI Number Information
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NPI Number | 1710435706
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Entity Type | Individual
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Provider Name | NIESHA STEVENS PTA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 3599 N CANAL RD
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City | MACCLENNY
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State | FL
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Zip | 32063-4830
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Country | US
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Telephone | 904-444-9622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33
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City | MACCLENNY
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State | FL
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Zip | 32063-0033
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Country | US
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Telephone | 904-444-9622
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number | PTA1970
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA19730
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License Number State | FL
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