Provider Demographics
NPI:1689266413
Name:STEVISON, JULIA M (PTA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:STEVISON
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 1:1076 RIBAUT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5490
Mailing Address - Country:US
Mailing Address - Phone:843-521-1970
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD STE 102
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5490
Practice Address - Country:US
Practice Address - Phone:843-521-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4583225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant