Provider Demographics
NPI:1992868129
Name:STOCKWELL, STEPHEN DAVID (PT , CSCS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DAVID
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:PT , CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ROBY RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NH
Mailing Address - Zip Code:03303-7409
Mailing Address - Country:US
Mailing Address - Phone:603-746-2406
Mailing Address - Fax:
Practice Address - Street 1:313 ROBY RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NH
Practice Address - Zip Code:03303-7409
Practice Address - Country:US
Practice Address - Phone:603-746-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist