Provider Demographics
NPI:1013475607
Name:STEVENSON, HALEY WILLIAMS (PT, DPT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:WILLIAMS
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:EVELY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:513 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4021
Practice Address - Country:US
Practice Address - Phone:662-268-8013
Practice Address - Fax:662-268-8095
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18608225100000X
MSPT7070225100000X
SC9559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist