Provider Demographics
NPI:1164713087
Name:STEVENS, LANA P (PTA)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:P
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W HOUSATONIC ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6647
Mailing Address - Country:US
Mailing Address - Phone:413-770-7264
Mailing Address - Fax:
Practice Address - Street 1:406 W HOUSATONIC ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6647
Practice Address - Country:US
Practice Address - Phone:413-770-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist