1922661586 NPI number — DR. EMMA GERALDINE STEVENSON DPT

Table of content: DR. EMMA GERALDINE STEVENSON DPT (NPI 1922661586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922661586 NPI number — DR. EMMA GERALDINE STEVENSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENSON
Provider First Name:
EMMA
Provider Middle Name:
GERALDINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGRATH
Provider Other First Name:
EMMA
Provider Other Middle Name:
GERALDINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922661586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
0N321 COUNTY FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60190-1889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-212-9494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1535 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-232-0883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  090171 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)