Provider Demographics
NPI:1881809986
Name:STEVENS, DENISE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ELIZABETH
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 1:1037 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7133
Mailing Address - Country:US
Mailing Address - Phone:802-254-3570
Mailing Address - Fax:
Practice Address - Street 1:54 HARRIS PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7127
Practice Address - Country:US
Practice Address - Phone:802-258-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2007Medicaid
VT00029118Medicare UPIN
VT698774Medicare UPIN
VT0VN2007Medicaid
VT7400920Medicare UPIN