Basic Information
| Provider Information | |||||||||
| NPI: | 1497872071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENSON | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25241 ELEMENTARY WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | BONITA SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341357883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399492855 | ||||||||
| FaxNumber: | 2399474171 | ||||||||
| Practice Location | |||||||||
| Address1: | 15620 MCGREGOR BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339082528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394546262 | ||||||||
| FaxNumber: | 2394540350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT2829 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT2829 | 01 | FL | PHYSICAL THERAPIST LICENS | OTHER |