Provider Demographics
NPI:1720708316
Name:STEPHENS, KARRIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 AVON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 AVON ST
Practice Address - Street 2:SUITE A
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4982
Practice Address - Country:US
Practice Address - Phone:307-210-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist