Provider Demographics
NPI:1649251091
Name:STEVENSON, MEKEIA H (PT)
Entity type:Individual
Prefix:
First Name:MEKEIA
Middle Name:H
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEKEIA
Other - Middle Name:D
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4123 ASHMORE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6301
Mailing Address - Country:US
Mailing Address - Phone:336-708-9266
Mailing Address - Fax:
Practice Address - Street 1:6320A W UNION HILLS DR
Practice Address - Street 2:STE 265
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1098
Practice Address - Country:US
Practice Address - Phone:623-374-2424
Practice Address - Fax:623-374-2619
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9619225100000X
AZ9447225100000X
VA2023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ155550OtherMEDICARE PTAN
NC7211729Medicaid
NCP00319082OtherMEDICARE RAILROAD
NC079RXOtherBLUE CROSS BLUE SHIELD
NCE2225OtherMEDCOST
NC2507082Medicare ID - Type Unspecified