Provider Demographics
NPI:1205010048
Name:HASSIBI, STEPHANIE D (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:HASSIBI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:CIGRANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5611 PALMER WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7253
Mailing Address - Country:US
Mailing Address - Phone:760-603-9166
Mailing Address - Fax:760-603-9161
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:#365
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-587-8669
Practice Address - Fax:858-587-8675
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist