1093898280 NPI number — MS. ROSCHELLA Y STEPHENS PT, MS, SCS

Table of content: MILAGROS BAGUE (NPI 1477524528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093898280 NPI number — MS. ROSCHELLA Y STEPHENS PT, MS, SCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
ROSCHELLA
Provider Middle Name:
Y
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MS, SCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAYTOR
Provider Other First Name:
ROSCHELLA
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, MS, SCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093898280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 PARK RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-323-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9848 N TRYON ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-323-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

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:  8483 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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