Provider Demographics
NPI:1558416735
Name:STEVENS, LAURA MARIA (MA, PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-3310
Mailing Address - Country:US
Mailing Address - Phone:845-928-2426
Mailing Address - Fax:845-928-8182
Practice Address - Street 1:583 ROUTE 32
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930
Practice Address - Country:US
Practice Address - Phone:845-928-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR72677Medicare UPIN
NYQ63271Medicare ID - Type Unspecified