Provider Demographics
NPI:1881637114
Name:STEVENS, MICHELE G (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:G
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:G
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:416 KNOWLES RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-3941
Mailing Address - Country:US
Mailing Address - Phone:207-620-2615
Mailing Address - Fax:
Practice Address - Street 1:14 2ND ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344
Practice Address - Country:US
Practice Address - Phone:207-582-9898
Practice Address - Fax:207-582-9899
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist