Provider Demographics
NPI:1578687158
Name:STEVENSON, ROBERT AUGUSTUS (ATC,LAT,CSCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:AUGUSTUS
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:ATC,LAT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 BENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4231
Mailing Address - Country:US
Mailing Address - Phone:817-360-5859
Mailing Address - Fax:817-563-3717
Practice Address - Street 1:901 WILDCAT WAY
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-5848
Practice Address - Country:US
Practice Address - Phone:817-563-8133
Practice Address - Fax:817-563-3717
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer