Provider Demographics
NPI:1376821827
Name:STEPHENS, CASEY STEVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:STEVEN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 W NORTH CARRIER PKWY
Mailing Address - Street 2:SUITE110
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1288
Mailing Address - Country:US
Mailing Address - Phone:972-206-7345
Mailing Address - Fax:972-522-0103
Practice Address - Street 1:1517 W NORTH CARRIER PKWY
Practice Address - Street 2:SUITE110
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1288
Practice Address - Country:US
Practice Address - Phone:972-206-7345
Practice Address - Fax:972-522-0103
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136380225100000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0570710005Medicare NSC
TX016925201Medicaid