Provider Demographics
NPI:1013192194
Name:STEVENS, TERESA BETH (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:BETH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 BYRNES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2034
Mailing Address - Country:US
Mailing Address - Phone:803-279-7512
Mailing Address - Fax:
Practice Address - Street 1:310 BARNWELL AVE NE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4406
Practice Address - Country:US
Practice Address - Phone:803-641-4144
Practice Address - Fax:803-641-4147
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0015Medicaid