Provider Demographics
NPI:1073071049
Name:STEVENS, MARCIA TRAVISS (PT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:TRAVISS
Last Name:STEVENS
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 1:1266 KNOLLWOOD ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5459
Mailing Address - Country:US
Mailing Address - Phone:864-706-7499
Mailing Address - Fax:
Practice Address - Street 1:151 RIBAULT ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2630
Practice Address - Country:US
Practice Address - Phone:864-560-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist