Provider Demographics
NPI:1629194733
Name:STEVENS, MICHAEL (PT6375)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PT6375
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 LOMBARD ST
Practice Address - Street 2:#310
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8211
Practice Address - Country:US
Practice Address - Phone:805-382-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist