Provider Demographics
NPI:1881056299
Name:CALDERON, STEPHEN ALEX (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALEX
Last Name:CALDERON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3700 N 24TH ST
Mailing Address - Street 2:STE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6534
Mailing Address - Country:US
Mailing Address - Phone:480-607-9207
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5225
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-782-5213
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist