Basic Information
| Provider Information | |||||||||
| NPI: | 1851872386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | EVONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 SEVEN OAKS RD | ||||||||
| Address2: | |||||||||
| City: | BONHAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754183237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038183190 | ||||||||
| FaxNumber: | 9035832759 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 SEVEN OAKS RD | ||||||||
| Address2: | |||||||||
| City: | BONHAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754183237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038183190 | ||||||||
| FaxNumber: | 9035832759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2056893 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.