Provider Demographics
NPI:1205998630
Name:STEVENS, CRYSTAL (LPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:9300 STONESTREET RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2876
Mailing Address - Country:US
Mailing Address - Phone:502-935-9776
Mailing Address - Fax:502-935-9813
Practice Address - Street 1:9300 STONESTREET RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2876
Practice Address - Country:US
Practice Address - Phone:502-935-9776
Practice Address - Fax:502-935-9813
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0043172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000346353OtherANTHEM BLUE SHIELD
KYP00417175OtherRAILROAD MEDICARE
KY0273211Medicare PIN