Provider Demographics
NPI:1467673038
Name:STEVENS, SUSAN WELCH (EDD, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WELCH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:EDD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 PINECREST STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO
Practice Address - Street 2:DEPARTMENT OF EXERCISE AND SPORTS SCIENCE, 237A HHP
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412
Practice Address - Country:US
Practice Address - Phone:336-334-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer