Provider Demographics
NPI:1760880876
Name:STEVENS, SYDNEY MORGAN (MASSAGE THERAPY)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MORGAN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-1631
Mailing Address - Country:US
Mailing Address - Phone:541-227-4640
Mailing Address - Fax:541-665-1749
Practice Address - Street 1:830 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6739
Practice Address - Country:US
Practice Address - Phone:541-227-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist