Individual
MR. PHILIP JAY STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
200 BLOOMFIELD AVE, WEST HARTFORD, CT 06117-1599
(623) 521-6312
Mailing address
47 VILLAGE LN APT 811, WETHERSFIELD, CT 06109-1084
(623) 521-6312
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001270
CT
Other
Enumeration date
01/05/2019
Last updated
01/05/2019
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