Provider Demographics
NPI:1851659585
Name:STEPHENSON, TERRANCE J
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:J
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:
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 8514
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-0009
Mailing Address - Country:US
Mailing Address - Phone:775-881-8249
Mailing Address - Fax:
Practice Address - Street 1:157 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-5203
Practice Address - Country:US
Practice Address - Phone:775-881-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner