Healthcare Provider Details

I. General information

NPI: 1164582946
Provider Name (Legal Business Name): ALLISON SWANSON STEVENSON MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR 3RD FLOOR, REHAB
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR KAISER FOUNDATION REHABILITATION CENTER
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-4450
  • Fax:
Mailing address:
  • Phone: 707-651-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number28778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: