Provider Demographics
NPI:1275524142
Name:HALLAN, STEVEN CAMPBELL (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CAMPBELL
Last Name:HALLAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 SAN JOSE PL
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-7015
Mailing Address - Country:US
Mailing Address - Phone:775-848-3954
Mailing Address - Fax:
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 605
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC9598OtherBC/BS
NV003416276Medicaid
101204Medicare ID - Type Unspecified