MEDICARE: MR. ERIC R STEVENS MPT

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	174400000X	Specialist	04378	LA
2	225100000X	Physical Therapist	1247921	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212607	OTHER	LA	COVENTRY

General Provider Information

NPI Number	:	1508945379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC R STEVENS MPT

Provider Business Mailing Address
First Line	:	601 ROCKMEAD DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2107
Country	:	US
Telephone Number	:	713-814-2530
Fax Number	:	713-704-3844

Provider Business Practice Location Address
First Line	:	601 ROCKMEAD DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2107
Country	:	US
Telephone Number	:	713-814-2530
Fax Number	:	713-704-3844

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/03/2020

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