Provider Demographics
NPI:1174956080
Name:STEVENS, CYNTHIA E (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 QUARRY ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4174
Mailing Address - Country:US
Mailing Address - Phone:617-770-4167
Mailing Address - Fax:617-770-0971
Practice Address - Street 1:104 QUARRY ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4174
Practice Address - Country:US
Practice Address - Phone:617-770-4167
Practice Address - Fax:617-770-0971
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic