Provider Demographics
NPI:1932124179
Name:STEVENS & DILLINGER PHYSICAL THERAPY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:STEVENS & DILLINGER PHYSICAL THERAPY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-610-7700
Mailing Address - Street 1:PO BOX 30708
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3708
Mailing Address - Country:US
Mailing Address - Phone:405-610-7700
Mailing Address - Fax:405-610-7676
Practice Address - Street 1:8851 E RENO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7724
Practice Address - Country:US
Practice Address - Phone:405-610-7700
Practice Address - Fax:405-610-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDG4179OtherRR MEDICARE
OKDG4179OtherRR MEDICARE
OK=========OtherTRICARE
OK300522234Medicare PIN