Provider Demographics
NPI:1114694585
Name:STEVENS, DRAKE CHRISTIAN (PT)
Entity Type:Individual
Prefix:
First Name:DRAKE
Middle Name:CHRISTIAN
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N CATTLEMEN RD APT 9-305
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6460
Mailing Address - Country:US
Mailing Address - Phone:941-961-4421
Mailing Address - Fax:
Practice Address - Street 1:8588 POTTER PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5471
Practice Address - Country:US
Practice Address - Phone:941-361-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist