Provider Demographics
NPI:1801916416
Name:STEPHENSON, CHARLES BELL II (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BELL
Last Name:STEPHENSON
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 S CARRUTH LN
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7338
Mailing Address - Country:US
Mailing Address - Phone:817-491-0675
Mailing Address - Fax:817-491-0681
Practice Address - Street 1:10010 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5001
Practice Address - Country:US
Practice Address - Phone:972-401-4774
Practice Address - Fax:972-401-0800
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1061596OtherPHYSICAL THERAPY LICENSE
TX873080OtherAETNA HMO
TX82672TOtherBLUE CROSS, BLUE SHIELD
TX5163185OtherAETNA PPO
TX873080OtherAETNA HMO