Provider Demographics
NPI:1306282264
Name:STEVENS, THEODORA J (DPT)
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:750 N SOCORA ST
Practice Address - Street 2:STE 400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3793
Practice Address - Country:US
Practice Address - Phone:316-440-3731
Practice Address - Fax:316-440-3741
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS11-04621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist