Individual
JEREMY STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1451 DIEDERICH BLVD, RUSSELL, KY 41169-1718
(606) 836-6683
Mailing address
1451 DIEDERICH BLVD, RUSSELL, KY 41169-1718
(606) 836-6683
(606) 324-0616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
004165
WV
225100000X
Physical Therapist
Primary
006678
KY
Other
Enumeration date
11/24/2016
Last updated
12/04/2023
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