Provider Demographics
NPI:1407176761
Name:STEVENS, CHARLES ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANTHONY
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1640
Mailing Address - Country:US
Mailing Address - Phone:570-282-9382
Mailing Address - Fax:570-227-1891
Practice Address - Street 1:27 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1640
Practice Address - Country:US
Practice Address - Phone:570-282-9382
Practice Address - Fax:570-227-1891
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist