Provider Demographics
NPI:1831140805
Name:STEPHENSON, LENDELL RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:LENDELL
Middle Name:RICHARD
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:L. RICHARD
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0177
Practice Address - Country:US
Practice Address - Phone:775-883-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT59770Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NV35376Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00PT59770Medicare ID - Type UnspecifiedMEDI-CAL PROVIDER NUMBER