Provider Demographics
NPI:1740695287
Name:STEPHENS, SEQUOIA (MPT)
Entity type:Individual
Prefix:
First Name:SEQUOIA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-9767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9312 LOTT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CA
Practice Address - Zip Code:95938-9767
Practice Address - Country:US
Practice Address - Phone:530-517-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist