Provider Demographics
NPI:1093898280
Name:STEPHENS, ROSCHELLA Y (PT, MS, SCS)
Entity Type:Individual
Prefix:MS
First Name:ROSCHELLA
Middle Name:Y
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT, MS, SCS
Other - Prefix:
Other - First Name:ROSCHELLA
Other - Middle Name:Y
Other - Last Name:CLAYTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MS, SCS
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:9848 N TRYON ST
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5512
Practice Address - Country:US
Practice Address - Phone:704-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist