Provider Demographics
NPI:1730698523
Name:GIVENS, STEPHANYE RENEE (PTA)
Entity type:Individual
Prefix:
First Name:STEPHANYE
Middle Name:RENEE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STEPHANYE
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:415 CROSSLAKE DR STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8263
Practice Address - Country:US
Practice Address - Phone:812-476-0409
Practice Address - Fax:812-476-0409
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant