Provider Demographics
NPI:1851872386
Name:STEVENS, SANDRA EVONNE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:EVONNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SEVEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-3237
Mailing Address - Country:US
Mailing Address - Phone:903-818-3190
Mailing Address - Fax:903-583-2759
Practice Address - Street 1:901 SEVEN OAKS RD
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3237
Practice Address - Country:US
Practice Address - Phone:903-818-3190
Practice Address - Fax:903-583-2759
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2056893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant