1265496558 NPI number — MS. HEIDI MARIE STEVENS ATC

Table of content: MS. HEIDI MARIE STEVENS ATC (NPI 1265496558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265496558 NPI number — MS. HEIDI MARIE STEVENS ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
HEIDI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265496558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 W OLSEN RD
Provider Second Line Business Mailing Address:
ATHLETICS AND EXERCISE SCIENCE
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-268-4720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 W OLSEN RD
Provider Second Line Business Practice Location Address:
ATHLETICS AND EXERCISE SCIENCE
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91360-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-268-4720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2006

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: 2255A2300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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