Provider Demographics
NPI:1679517056
Name:DUVAL, STEPHEN C (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:DUVAL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9245 SHADY GROVE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2890
Mailing Address - Country:US
Mailing Address - Phone:804-789-1180
Mailing Address - Fax:804-789-1181
Practice Address - Street 1:9245 SHADY GROVE RD
Practice Address - Street 2:STE 201
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2890
Practice Address - Country:US
Practice Address - Phone:804-789-1180
Practice Address - Fax:804-789-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305004572OtherVA LICENSE