Provider Demographics
NPI:1477764561
Name:STEPHENS, MICHAEL BURTON (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BURTON
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 1:6206 RIVERWALK LN UNIT 6
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7907
Mailing Address - Country:US
Mailing Address - Phone:561-339-1860
Mailing Address - Fax:
Practice Address - Street 1:JUPITER MEDICAL CENTER 1210 SOUTH OLD DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-745-5770
Practice Address - Fax:561-745-5776
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist