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General NPI Number Information
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NPI Number | 1972919405
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Entity Type | Individual
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Provider Name | STEPHEN NELSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/04/2014
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 5090 SHOREHAM PL STE 109
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City | SAN DIEGO
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State | CA
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Zip | 92122-5934
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Country | US
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Telephone | 206-228-3787
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Fax | 858-455-5000
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Provider Business Mailing Address
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Address Line | 5090 SHOREHAM PL STE 109
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City | SAN DIEGO
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State | CA
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Zip | 92122-5934
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Country | US
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Telephone | 206-228-3787
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Fax | 858-455-5000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 42597
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License Number State | CA
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