Individual
MR. CHARLES BELL STEPHENSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
10010 N MACARTHUR BLVD, IRVING, TX 75063-5001
(972) 401-4774
(972) 401-0800
Mailing address
204 S CARRUTH LN, DOUBLE OAK, TX 75077-7338
(817) 491-0675
(817) 491-0681
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1061596
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1061596
PHYSICAL THERAPY LICENSE
TX
01
—
5163185
AETNA PPO
TX
01
—
82672T
BLUE CROSS, BLUE SHIELD
TX
01
—
873080
AETNA HMO
TX
Enumeration date
03/29/2007
Last updated
07/08/2007
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