MEDICARE: STEVENS & DILLINGER PHYSICAL THERAPY SPECIALISTS, PLLC

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	1583	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG4179	OTHER	OK	RR MEDICARE

General Provider Information

NPI Number	:	1932124179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENS & DILLINGER PHYSICAL THERAPY SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 30708
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73140-3708
Country	:	US
Telephone Number	:	405-610-7700
Fax Number	:	405-610-7676

Provider Business Practice Location Address
First Line	:	8851 E RENO AVE
Second Line	:	SUITE 201
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7724
Country	:	US
Telephone Number	:	405-610-7700
Fax Number	:	405-610-7676

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JEFFREY CLARK STEVENS
Credential	:	P.T.
Telephone Number	:	405-610-7700

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/26/2012

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