Provider Demographics
NPI:1205965373
Name:STEVENS, CAROLLYNN (ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:CAROLLYNN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 FOOTPRINT DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-7414
Mailing Address - Country:US
Mailing Address - Phone:850-944-5230
Mailing Address - Fax:
Practice Address - Street 1:6229 FOOTPRINT DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-7414
Practice Address - Country:US
Practice Address - Phone:850-944-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer