Individual
MARK E STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
113 SMITH AVE, NAMPA, ID 83651-2322
(208) 615-6248
Mailing address
113 SMITH AVE, NAMPA, ID 83651-2322
(208) 615-6248
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-3298
ID
Other
Enumeration date
11/13/2016
Last updated
11/13/2016
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