Individual
MR. GERALD ALLEN STEVENS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
11945 SAN JOSE BLVD, SUITE 202, JACKSONVILLE, FL 32223-1613
(904) 880-2424
(904) 880-2420
Mailing address
11945 SAN JOSE BLVD, SUITE 202, JACKSONVILLE, FL 32223-1613
(904) 880-2424
(904) 880-2420
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL 428
STATE LICENSE
FL
Enumeration date
11/11/2005
Last updated
07/08/2007
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