Provider Demographics
NPI:1881997153
Name:STEVENS, CRAIG PATRICK (PTA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:PATRICK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PTA
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 7746
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33734-7746
Mailing Address - Country:US
Mailing Address - Phone:727-898-5001
Mailing Address - Fax:727-894-0554
Practice Address - Street 1:1236 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4210
Practice Address - Country:US
Practice Address - Phone:727-442-2236
Practice Address - Fax:727-442-2646
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18494225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant