Individual
BRYAN TODD STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1620 ALPINE BLVD, SUITE 211, ALPINE, CA 91901-1102
(619) 445-3168
(619) 445-5368
Mailing address
10525 HOLLINGSWORTH WAY, SAN DIEGO, CA 92127
(858) 693-7993
(619) 445-5368
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT26642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT266420
BLUE SHIELD COMMERCIAL
CA
05
—
PT0266420
—
CA
Enumeration date
10/03/2006
Last updated
10/14/2008
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