Provider Demographics
NPI:1740241702
Name:STEVENS, JASON ROGER (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROGER
Last Name:STEVENS
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 1:2454 MCMULLEN BOOTH RD
Mailing Address - Street 2:STE 411
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759
Mailing Address - Country:US
Mailing Address - Phone:727-725-8924
Mailing Address - Fax:727-725-4964
Practice Address - Street 1:2454 MCMULLEN BOOTH RD
Practice Address - Street 2:STE 411
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759
Practice Address - Country:US
Practice Address - Phone:727-725-8924
Practice Address - Fax:727-725-4964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2020-11-18
Deactivation Date:2020-10-12
Deactivation Code:
Reactivation Date:2020-11-18
Provider Licenses
StateLicense IDTaxonomies
FL16635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist