Provider Demographics
NPI:1740302116
Name:MORDECAI, STEVIE MARKHAM (PT)
Entity type:Individual
Prefix:MR
First Name:STEVIE
Middle Name:MARKHAM
Last Name:MORDECAI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:STEVIE
Other - Middle Name:MARKHAM
Other - Last Name:MORDECAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3701 LOOP RD
Mailing Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5015
Mailing Address - Country:US
Mailing Address - Phone:205-554-2822
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist