Provider Demographics
NPI:1780497172
Name:STEVENS, GARY WAYNE II
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:STEVENS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 EASTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6230
Mailing Address - Country:US
Mailing Address - Phone:614-216-0047
Mailing Address - Fax:
Practice Address - Street 1:990 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6230
Practice Address - Country:US
Practice Address - Phone:614-216-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist