Provider Demographics
NPI:1316900772
Name:STEVENSON, MARCI (MPT)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1214
Mailing Address - Country:US
Mailing Address - Phone:408-365-8396
Mailing Address - Fax:408-365-8397
Practice Address - Street 1:5434 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1214
Practice Address - Country:US
Practice Address - Phone:408-365-8396
Practice Address - Fax:408-365-8397
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT151751Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER