Healthcare Provider Details

I. General information

NPI: 1164782629
Provider Name (Legal Business Name): STEPHEN JOHN BAXTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
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

1162B GORGAS AVE
SAN FRANCISCO CA
94129-1406
US

V. Phone/Fax

Practice location:
  • Phone: 415-561-6655
  • Fax: 415-561-6650
Mailing address:
  • Phone: 415-561-6655
  • Fax: 415-561-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: