Provider Demographics
NPI:1093746638
Name:STEVENS, BURTON WILLIAM JR (DPT, SCS, ATC)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:WILLIAM
Last Name:STEVENS
Suffix:JR
Gender:M
Credentials:DPT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6884 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3229
Mailing Address - Country:US
Mailing Address - Phone:770-704-8244
Mailing Address - Fax:770-704-8264
Practice Address - Street 1:6884 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3229
Practice Address - Country:US
Practice Address - Phone:770-704-8244
Practice Address - Fax:770-704-8264
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17884225100000X
GAPT009114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650340OtherMEDICARE PTAN