Provider Demographics
NPI:1518065184
Name:PAULSETH, STEPHEN GIBBS (PT DPT SCS ATC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GIBBS
Last Name:PAULSETH
Suffix:
Gender:M
Credentials:PT DPT SCS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CENTURY PARK E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1705
Mailing Address - Country:US
Mailing Address - Phone:310-286-0447
Mailing Address - Fax:
Practice Address - Street 1:1950 CENTURY PARK E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-1705
Practice Address - Country:US
Practice Address - Phone:310-286-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT120292251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT12029AMedicare ID - Type Unspecified