Provider Demographics
NPI:1477598456
Name:STEVENS, KAREN MAE (MPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MAE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 PLAZA BLVD
Mailing Address - Street 2:SUITE C103
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1557
Mailing Address - Country:US
Mailing Address - Phone:252-208-0989
Mailing Address - Fax:252-208-0905
Practice Address - Street 1:704 PLAZA BLVD
Practice Address - Street 2:SUITE C103
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1557
Practice Address - Country:US
Practice Address - Phone:252-208-0989
Practice Address - Fax:252-208-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078HFOtherBCBSNC