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NPI Code Detail

MEDICARE: DR. STEPHEN GIBBS PAULSETH PT DPT SCS ATC

MEDICARE: DR. STEPHEN GIBBS PAULSETH PT DPT SCS ATC
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
12251S0007XSports Physical TherapistPT12029CA

General Provider Information

NPI Number : 1518065184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN GIBBS PAULSETH PT DPT SCS ATC
Provider Business Mailing Address
First Line : 1950 CENTURY PARK E
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-1705
Country : US
Telephone Number : 310-286-0447
Fax Number :
Provider Business Practice Location Address
First Line : 1950 CENTURY PARK E
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-1705
Country : US
Telephone Number : 310-286-0447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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