Provider Demographics
NPI:1194855890
Name:STEVENS, JOSH HAYDEN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:HAYDEN
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 OWNBY DR
Mailing Address - Street 2:PO BOX 750315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75275-0315
Mailing Address - Country:US
Mailing Address - Phone:214-768-1964
Mailing Address - Fax:214-768-1225
Practice Address - Street 1:5800 OWNBY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75275-0315
Practice Address - Country:US
Practice Address - Phone:214-768-1964
Practice Address - Fax:214-768-1225
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT2649OtherSTATE LICENSURE