Individual
NICHOLAS JOHN STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
257 W SAINT GEORGE AVE, GRANTSBURG, WI 54840-7827
(715) 463-5353
Mailing address
512 235TH AVE, CUMBERLAND, WI 54829-9307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3003-19
WI
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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