Provider Demographics
NPI:1154568301
Name:STEVENSON, JULIE A (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 24TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4506
Mailing Address - Country:US
Mailing Address - Phone:810-385-7405
Mailing Address - Fax:810-385-7420
Practice Address - Street 1:4351 24TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4506
Practice Address - Country:US
Practice Address - Phone:810-385-7405
Practice Address - Fax:810-385-7420
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013744261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy