Provider Demographics
NPI:1245445014
Name:STEVENS, RENEE LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:LYNN
Other - Last Name:BOUCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 NOKOMIS AVE S
Mailing Address - Street 2:STE. 204
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3209
Mailing Address - Country:US
Mailing Address - Phone:941-484-1939
Mailing Address - Fax:941-484-7804
Practice Address - Street 1:900 PINE ST
Practice Address - Street 2:STE. 127
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4418
Practice Address - Country:US
Practice Address - Phone:941-475-2022
Practice Address - Fax:941-473-1470
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT202242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4496768OtherAETNA
FLQ08OtherBCBS OF FL
FL4496768OtherAETNA