Provider Demographics
NPI:1457708133
Name:STEVENS, KEVIN (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2355
Mailing Address - Country:US
Mailing Address - Phone:716-790-8418
Mailing Address - Fax:716-790-8447
Practice Address - Street 1:610 WAYNE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2355
Practice Address - Country:US
Practice Address - Phone:716-790-8418
Practice Address - Fax:716-790-8447
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist