Healthcare Provider Details

I. General information

NPI: 1750407771
Provider Name (Legal Business Name): SEAN P STEPHAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 LOMA VISTA RD STE H
VENTURA CA
93003-1542
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-765-4773
  • Fax: 805-681-1768
Mailing address:
  • Phone: 805-681-1760
  • Fax: 805-681-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: