Provider Demographics
NPI:1215132220
Name:STEVENS, GINA R (PT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:STEVENS
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 1:6263 POPLAR AVE
Mailing Address - Street 2:STE 801
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4701
Mailing Address - Country:US
Mailing Address - Phone:901-685-7227
Mailing Address - Fax:267-321-2079
Practice Address - Street 1:7425 MISSION VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4409
Practice Address - Country:US
Practice Address - Phone:619-291-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 152082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ591ZMedicare PIN
CAW17215Medicare PIN