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NPI Code Detail

MEDICARE: KELLY ANN STEVENS PT

MEDICARE: KELLY ANN 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
1225100000XPhysical TherapistAZ923AZ

General Provider Information

NPI Number : 1689609570
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANN STEVENS PT
Provider Business Mailing Address
First Line : 15615 S 6TH PL
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-6305
Country : US
Telephone Number : 480-688-2947
Fax Number :
Provider Business Practice Location Address
First Line : 2211 E SOUTHERN AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-3408
Country : US
Telephone Number : 602-305-7134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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