Provider Demographics
NPI:1124072830
Name:STEVENSON, ERNEST MILES (PT)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:MILES
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1611
Mailing Address - Country:US
Mailing Address - Phone:540-828-6443
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL PARK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8805
Practice Address - Country:US
Practice Address - Phone:910-215-0541
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH8000070OtherFIRST CAROLINA CARE
NC079YWOtherANTHEM
NCFH8000070OtherFIRST CAROLINA CARE