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NPI Code Detail

MEDICARE: MARQUIS STEVENSON

MEDICARE: MARQUIS STEVENSON
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
1225200000XPhysical Therapy AssistantPTA2176MS

General Provider Information

NPI Number : 1124232293
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARQUIS STEVENSON
Provider Business Mailing Address
First Line : 112 LAKES DR S
Second Line :
City : OXFORD
State : MS
Zip : 38655-9213
Country : US
Telephone Number : 601-250-4815
Fax Number : 601-250-6859
Provider Business Practice Location Address
First Line : 206 MARYLAND AVE
Second Line :
City : MCCOMB
State : MS
Zip : 39648-3926
Country : US
Telephone Number : 601-250-4815
Fax Number : 601-250-6859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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Directions to “ MARQUIS STEVENSON ” Practice Location

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