Provider Demographics
NPI:1366430951
Name:STEPHENSON, MARK DAVID (ATC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12424 ANGELINA DR
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8465
Mailing Address - Country:US
Mailing Address - Phone:719-495-7328
Mailing Address - Fax:
Practice Address - Street 1:1885 BOB JOHNSON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4000
Practice Address - Country:US
Practice Address - Phone:719-632-6722
Practice Address - Fax:719-632-6367
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer