Provider Demographics
NPI:1629029145
Name:STEVENS, JEFFREY CLARK (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CLARK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SKIP
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30708
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3708
Mailing Address - Country:US
Mailing Address - Phone:405-610-7700
Mailing Address - Fax:
Practice Address - Street 1:201 HARROZ LN
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7722
Practice Address - Country:US
Practice Address - Phone:405-610-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00434601OtherRR MEDICARE