Provider Demographics
NPI:1609803568
Name:STEVENS, ROXANNA D (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNA
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1379
Mailing Address - Country:US
Mailing Address - Phone:479-524-8028
Mailing Address - Fax:479-524-6151
Practice Address - Street 1:1675 W. JEFFERSON
Practice Address - Street 2:SUITE A
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-1379
Practice Address - Country:US
Practice Address - Phone:479-524-8028
Practice Address - Fax:479-524-6151
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2193225100000X
OK2900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U653Medicare ID - Type Unspecified