Provider Demographics
NPI:1043574593
Name:STEPHENS, PAMELA N (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:N
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 PRISCILLA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1524
Mailing Address - Country:US
Mailing Address - Phone:858-672-7857
Mailing Address - Fax:858-672-0337
Practice Address - Street 1:14805 PRISCILLA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1524
Practice Address - Country:US
Practice Address - Phone:858-672-7857
Practice Address - Fax:858-672-0337
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN18989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist