Provider Demographics
NPI:1508945379
Name:STEVENS, ERIC R (MPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ROCKMEAD DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2107
Mailing Address - Country:US
Mailing Address - Phone:713-814-2530
Mailing Address - Fax:713-704-3844
Practice Address - Street 1:601 ROCKMEAD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2107
Practice Address - Country:US
Practice Address - Phone:713-814-2530
Practice Address - Fax:713-704-3844
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04378174400000X
TX1247921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA212607OtherCOVENTRY
LA212607OtherCOVENTRY