Provider Demographics
NPI:1689642407
Name:STEVENSON, MARY (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 ATWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3289
Mailing Address - Country:US
Mailing Address - Phone:401-270-5395
Mailing Address - Fax:401-270-7635
Practice Address - Street 1:1526 ATWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3289
Practice Address - Country:US
Practice Address - Phone:401-270-5395
Practice Address - Fax:401-270-7635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT0377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist