Provider Demographics
NPI:1699840884
Name:DUVALL, STEPHEN T (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:T
Last Name:DUVALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 140TH AVE N STE 313
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3841
Mailing Address - Country:US
Mailing Address - Phone:727-223-8978
Mailing Address - Fax:727-303-3952
Practice Address - Street 1:333 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-223-8978
Practice Address - Fax:727-303-3952
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9908174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106866Medicare ID - Type Unspecified