Provider Demographics
NPI:1760510382
Name:ORIG-STEVENS, MARIANNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:
Last Name:ORIG-STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9261 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2941
Mailing Address - Country:US
Mailing Address - Phone:623-936-9740
Mailing Address - Fax:623-907-5178
Practice Address - Street 1:9261 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2941
Practice Address - Country:US
Practice Address - Phone:623-936-9740
Practice Address - Fax:623-907-5178
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ576564OtherPHYSICAL THERAPIST