Provider Demographics
NPI:1003950940
Name:STEVENS, SUE M (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:SUE
Other - Middle Name:M
Other - Last Name:GRABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:15955 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1227
Mailing Address - Country:US
Mailing Address - Phone:314-953-5000
Mailing Address - Fax:
Practice Address - Street 1:12555 PARTRIDGE RUN DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5015
Practice Address - Country:US
Practice Address - Phone:314-741-4126
Practice Address - Fax:314-741-4450
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist