Individual
MATTHEW STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1020 35TH ST STE 110, KENOSHA, WI 53140-1932
(262) 925-1480
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17159
WI
261QP2000X
Physical Therapy Clinic/Center
17159-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100328994
—
WI
Enumeration date
05/27/2025
Last updated
11/17/2025
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