Provider Demographics
NPI:1740787498
Name:STEVENSON, STEVE (LMT)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 YORK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1326
Mailing Address - Country:US
Mailing Address - Phone:215-528-4490
Mailing Address - Fax:
Practice Address - Street 1:1000 N YORK RD STE 1
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1326
Practice Address - Country:US
Practice Address - Phone:215-528-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist