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NPI Code Detail

MEDICARE: STEPHEN GANT DPT

MEDICARE: STEPHEN GANT DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist300232CA

General Provider Information

NPI Number : 1235709411
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN GANT DPT
Provider Business Mailing Address
First Line : 6974 CARMELA WAY
Second Line :
City : FONTANA
State : CA
Zip : 92336-1491
Country : US
Telephone Number : 443-315-6599
Fax Number :
Provider Business Practice Location Address
First Line : 1760 CHICAGO AVE STE J3
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2358
Country : US
Telephone Number : 951-781-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2021
Last Update Date : 06/29/2021

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Directions to “ STEPHEN GANT DPT” Practice Location

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