Provider Demographics
NPI:1497422430
Name:DOUB, STEPHEN (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DOUB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BAYCREST CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2920
Mailing Address - Country:US
Mailing Address - Phone:831-331-3654
Mailing Address - Fax:
Practice Address - Street 1:485 E 17TH ST STE 650
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4706
Practice Address - Country:US
Practice Address - Phone:949-722-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist