Provider Demographics
NPI:1326553876
Name:STEVENSON, DONALD ROBERT (BSC(PT))
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:BSC(PT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S LONGYARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9328
Mailing Address - Country:US
Mailing Address - Phone:413-569-0805
Mailing Address - Fax:
Practice Address - Street 1:705 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4039
Practice Address - Country:US
Practice Address - Phone:860-953-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist