Provider Demographics
NPI:1760779334
Name:STEPHENS, CALLIE PAIGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:PAIGE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:PAIGE
Other - Last Name:MOSIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:225 N MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1928
Practice Address - Country:US
Practice Address - Phone:913-856-7927
Practice Address - Fax:913-856-8442
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20-11018907225100000X
KS11-04253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
15790066OtherBCBS KC
MOMA4370039OtherMEDICARE PTAN
778706OtherOPTUM
KSKA2868044OtherMEDICARE PTAN
MO45790026OtherBCBS KC