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General NPI Number Information
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NPI Number | 1831222363
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Entity Type | Individual
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Provider Name | MARY ELLEN STEPHENSON BSPT
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 502 W 5TH ST MSSD SKYVIEW SCHOOL #30
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-1435
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Country | US
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Telephone | 417-926-4880
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Fax | 417-926-5044
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Provider Business Mailing Address
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Address Line | 3338 KNOW IT ALL LN
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City | ROGERSVILLE
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State | MO
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Zip | 65742-7599
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Country | US
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Telephone | 417-860-6319
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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 | 00476
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 00476
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 00476
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License Number State | MO
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