Provider Demographics
NPI:1851301865
Name:STEVENS, MARTIN (PT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E STATE PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4569
Mailing Address - Country:US
Mailing Address - Phone:630-285-8007
Mailing Address - Fax:630-285-8017
Practice Address - Street 1:1000 WELLINGTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7332
Practice Address - Country:US
Practice Address - Phone:847-437-7070
Practice Address - Fax:847-437-1080
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist