Healthcare Provider Details

I. General information

NPI: 1083260582
Provider Name (Legal Business Name): LAUREL STEPHENS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162B GORGAS AVE
SAN FRANCISCO CA
94129-1406
US

IV. Provider business mailing address

422 RUSSIA AVE
SAN FRANCISCO CA
94112-2853
US

V. Phone/Fax

Practice location:
  • Phone: 415-561-6655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: