Provider Demographics
NPI:1215166517
Name:STEVENS, KATHERINE ALICIA (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALICIA
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:9430 PARK WEST BLVD STE 230
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-560-8550
Practice Address - Fax:865-560-8551
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515008Medicaid
TN0677340010Medicare NSC
TN36460392Medicare PIN
TN0677340003Medicare NSC
TN0677340005Medicare NSC
TN0677340004Medicare NSC
TN0677340001Medicare NSC