Provider Demographics
NPI:1184128597
Name:BEVILACQUA, STEVEN MICHAEL
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:BEVILACQUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 CHESWICK LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8638
Mailing Address - Country:US
Mailing Address - Phone:610-680-7302
Mailing Address - Fax:
Practice Address - Street 1:2494 CHESWICK LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8638
Practice Address - Country:US
Practice Address - Phone:610-680-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31432251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics