=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295974673
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN JEAN STONE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2009
-----------------------------------------------------
Last Update Date | 02/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9610 GRANITE RIDGE DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-2684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-505-5400
-----------------------------------------------------
Fax | 858-505-5459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5651 COPLEY DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 35403
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------