Provider Demographics
NPI:1740268564
Name:STEVENSON, DAVID BRIAN (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 WOOD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7928
Mailing Address - Country:US
Mailing Address - Phone:941-330-1677
Mailing Address - Fax:941-330-1688
Practice Address - Street 1:2055 WOOD ST STE 110
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7928
Practice Address - Country:US
Practice Address - Phone:941-330-1677
Practice Address - Fax:941-330-1688
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3935ZMedicare ID - Type UnspecifiedMEDICARE SUPPLIER SUFFIX