Provider Demographics
NPI:1184102113
Name:STEVENSON, KATHERINE LYNNE (DPT)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:LYNNE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:LYNNE
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KATIE STEVENSON
Mailing Address - Street 1:420 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1102
Mailing Address - Country:US
Mailing Address - Phone:828-699-6373
Mailing Address - Fax:
Practice Address - Street 1:374 KROGER WAY
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1915
Practice Address - Country:US
Practice Address - Phone:859-286-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist