Provider Demographics
NPI:1235251984
Name:STEVENS, ELIZABETH G (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 ASHLEY ST E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-5306
Mailing Address - Country:US
Mailing Address - Phone:912-383-4934
Mailing Address - Fax:912-383-4934
Practice Address - Street 1:211 ASHLEY ST E
Practice Address - Street 2:SUITE 103
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5306
Practice Address - Country:US
Practice Address - Phone:912-383-4934
Practice Address - Fax:912-383-4934
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33300225700000X
GAMT003853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist