Provider Demographics
NPI:1609339993
Name:STEVENSON, KRISTIANA (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3333
Mailing Address - Country:US
Mailing Address - Phone:609-828-1299
Mailing Address - Fax:
Practice Address - Street 1:1900 ARENA DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-2426
Practice Address - Country:US
Practice Address - Phone:609-585-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00323200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant