Provider Demographics
NPI:1669897013
Name:STEPHENS, ROBERTA (PT)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 OLD LEBANON DIRT RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2386
Mailing Address - Country:US
Mailing Address - Phone:615-391-4545
Mailing Address - Fax:
Practice Address - Street 1:913 CONFERENCE DR STE 104
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-604-5707
Practice Address - Fax:615-859-5577
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist