Provider Demographics
NPI:1417953738
Name:STEPHENS, DAWN LARAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LARAE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W 6TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2355
Mailing Address - Country:US
Mailing Address - Phone:785-460-7848
Mailing Address - Fax:785-460-7849
Practice Address - Street 1:135 W 6TH ST STE 8
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2355
Practice Address - Country:US
Practice Address - Phone:785-460-7848
Practice Address - Fax:785-460-7849
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-04-30
Deactivation Date:2005-06-30
Deactivation Code:
Reactivation Date:2005-07-01
Provider Licenses
StateLicense IDTaxonomies
KS11-02001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10325OtherTRIWEST
KS61143300OtherFEDERAL WORK COMP
KS100319840CMedicaid
KSP00183406OtherRAIL ROAD MEDICARE
KS140660OtherBCBS
KS61143300OtherFEDERAL WORK COMP
KS10325OtherTRIWEST
140660Medicare ID - Type Unspecified