Provider Demographics
NPI:1710576087
Name:STEVENS, HEATHER L (ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-3526
Mailing Address - Country:US
Mailing Address - Phone:225-301-4282
Mailing Address - Fax:
Practice Address - Street 1:5610 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:GREENBACK
Practice Address - State:TN
Practice Address - Zip Code:37742-3526
Practice Address - Country:US
Practice Address - Phone:225-301-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8267R225200000X
TN24722255A2300X
TNPTA0000007023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer