Provider Demographics
NPI:1740597574
Name:POPE, STEPHEN WESLEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:POPE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45573 VIA JACA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1307
Mailing Address - Country:US
Mailing Address - Phone:951-907-7269
Mailing Address - Fax:
Practice Address - Street 1:3800 CONCOURS
Practice Address - Street 2:SUITE 350
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:909-989-5699
Practice Address - Fax:909-989-7633
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4372171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor