MEDICARE: MRS. MOLLY ANN STEVENS DPT

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	05009602A	IN
2	225100000X	Physical Therapist	10642	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000611574	OTHER	IN	ANTHEM BC/BS

General Provider Information

NPI Number	:	1154572691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLY ANN STEVENS DPT

Provider Business Mailing Address
First Line	:	8500 STATION ST # 255
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4943
Country	:	US
Telephone Number	:	440-725-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 STATION ST # 255
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4943
Country	:	US
Telephone Number	:	440-725-0703
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	03/17/2018

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