Provider Demographics
NPI:1154479582
Name:GOUVEIA, STEPHEN GIVINAL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GIVINAL
Last Name:GOUVEIA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:155 MILLENIUM DR
Mailing Address - Street 2:LAKEVILLE PHYSICAL THERAPY INC SUITE 114
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347
Mailing Address - Country:US
Mailing Address - Phone:508-947-3004
Mailing Address - Fax:508-923-6008
Practice Address - Street 1:155 MILLENIUM DR
Practice Address - Street 2:LAKEVILLE PHYSICAL THERAPY INC SUITE 114
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347
Practice Address - Country:US
Practice Address - Phone:508-947-3004
Practice Address - Fax:508-923-6008
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA5869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9739190Medicaid
MAAA20786OtherHPHC
MAY61391OtherBCBS