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1073596086

NPI Code Detail

MEDICARE: MR. RICHARD DALE STEVENS PT

MEDICARE: MR. RICHARD DALE STEVENS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	288	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073596086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD DALE STEVENS PT

Provider Business Mailing Address
First Line	:	2010 ACTIVE WAY
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-0000
Country	:	US
Telephone Number	:	501-315-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 ACTIVE WAY
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-0000
Country	:	US
Telephone Number	:	501-315-0984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	10/04/2012

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Directions to “ MR. RICHARD DALE STEVENS PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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