Provider Demographics
NPI:1700486636
Name:STEVENSON, RACHEL BETH (PTA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BETH
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S LONGYARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9328
Mailing Address - Country:US
Mailing Address - Phone:203-915-8623
Mailing Address - Fax:
Practice Address - Street 1:652 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2906
Practice Address - Country:US
Practice Address - Phone:860-673-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT627225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant