Provider Demographics
NPI:1588385405
Name:STEVENS, LAURA BRANTLEY (DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BRANTLEY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 E EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4503
Mailing Address - Country:US
Mailing Address - Phone:479-770-0788
Mailing Address - Fax:479-770-0790
Practice Address - Street 1:922 E EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4503
Practice Address - Country:US
Practice Address - Phone:479-770-0788
Practice Address - Fax:479-770-0790
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty