Provider Demographics
NPI:1851591291
Name:STEVENS, GINA RUTH (PT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:RUTH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7432
Mailing Address - Country:US
Mailing Address - Phone:704-647-9865
Mailing Address - Fax:704-647-9865
Practice Address - Street 1:135 PRIMROSE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7432
Practice Address - Country:US
Practice Address - Phone:704-647-9865
Practice Address - Fax:704-647-9865
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist