Provider Demographics
NPI:1902042963
Name:GETTELFINGER, STEVEN THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THOMAS
Last Name:GETTELFINGER
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:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-0662
Mailing Address - Country:US
Mailing Address - Phone:865-338-2373
Mailing Address - Fax:
Practice Address - Street 1:2648 MAIN ST
Practice Address - Street 2:SUITE BC
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4664
Practice Address - Country:US
Practice Address - Phone:619-246-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT12768OtherLICENSE