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General NPI Number Information
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NPI Number | 1801916416
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Entity Type | Individual
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Provider Name | CHARLES BELL STEPHENSON II P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10010 N MACARTHUR BLVD
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City | IRVING
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State | TX
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Zip | 75063-5001
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Country | US
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Telephone | 972-401-4774
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Fax | 972-401-0800
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Provider Business Mailing Address
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Address Line | 204 S CARRUTH LN
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City | DOUBLE OAK
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State | TX
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Zip | 75077-7338
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Country | US
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Telephone | 817-491-0675
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Fax | 817-491-0681
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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 | 1061596
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License Number State | TX
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