Provider Demographics
NPI:1487894374
Name:STEVENSON, DACHISA ANDERSON (PT)
Entity type:Individual
Prefix:MRS
First Name:DACHISA
Middle Name:ANDERSON
Last Name:STEVENSON
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 1:5411 W GWEN ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7162
Mailing Address - Country:US
Mailing Address - Phone:602-237-0504
Mailing Address - Fax:
Practice Address - Street 1:13575 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2604
Practice Address - Country:US
Practice Address - Phone:623-512-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist