Provider Demographics
NPI:1437329679
Name:STEVENS, MARK (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6645
Mailing Address - Country:US
Mailing Address - Phone:561-289-1257
Mailing Address - Fax:561-750-7810
Practice Address - Street 1:1288 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-6645
Practice Address - Country:US
Practice Address - Phone:561-289-1257
Practice Address - Fax:561-750-7810
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist