Healthcare Provider Details

I. General information

NPI: 1215132220
Provider Name (Legal Business Name): GINA R STEVENS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 MISSION VALLEY RD SUITE 201
SAN DIEGO CA
92108-4409
US

IV. Provider business mailing address

6263 POPLAR AVE STE 801
MEMPHIS TN
38119-4701
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-3400
  • Fax:
Mailing address:
  • Phone: 901-685-7227
  • Fax: 267-321-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 15208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: