Provider Demographics
NPI:1831463108
Name:STEVICK, CAROL (DPT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:STEVICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11462 LA VEREDA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7403
Mailing Address - Country:US
Mailing Address - Phone:415-342-9691
Mailing Address - Fax:
Practice Address - Street 1:11462 LA VEREDA DR
Practice Address - Street 2:
Practice Address - City:NORTH TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92705-7403
Practice Address - Country:US
Practice Address - Phone:415-342-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist