Provider Demographics
NPI:1497792105
Name:STEVENSON, KATRINA JOY (PT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JOY
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JOY
Other - Last Name:LAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:493 MARY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1127
Mailing Address - Country:US
Mailing Address - Phone:609-702-8386
Mailing Address - Fax:
Practice Address - Street 1:163 ROUTE 130
Practice Address - Street 2:SUITE A-1 BLD 2
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505
Practice Address - Country:US
Practice Address - Phone:609-324-9320
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA007403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316614Medicare ID - Type Unspecified