Provider Demographics
NPI:1649335787
Name:MEDCALF, STEPHEN WESLEY (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WESLEY
Last Name:MEDCALF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 SHELL CT
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6159
Mailing Address - Country:US
Mailing Address - Phone:559-686-6356
Mailing Address - Fax:
Practice Address - Street 1:3362 S FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8109
Practice Address - Country:US
Practice Address - Phone:559-625-2476
Practice Address - Fax:559-625-2479
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT195750Medicare ID - Type UnspecifiedMEDICARE PT ID NUMBER