Individual provider Active NPI

Stephanie Alldredge, PT

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fullerton, CA
National Provider Identifier
1598024432
Registry record updated May 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
License
PT38600 Issued in CA
Practice address
1027 N Harbor Blvd # B
Fullerton, CA 92832-1310
Phone
(714) 870-8478
Fax
(714) 870-8405
NPI assigned
May 13, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X PT38600 CA Primary

Addresses

Primary practice location

1027 N Harbor Blvd # B
Fullerton, CA 92832-1310

Mailing address

1027 N Harbor Blvd # B
Fullerton, CA 92832-1310
Phone (714) 870-8478

Other identifiers 1

IdentifierTypeStateIssuer
PT38600OtherCALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT38600CAMDSports Medicine (Physical Medicine & Rehabilitation) Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336867200000",
    "number": "1598024432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 N HARBOR BLVD # B",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928321310",
            "telephone_number": "714-870-8478",
            "fax_number": "714-870-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 N HARBOR BLVD # B",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928321310",
            "telephone_number": "714-870-8478",
            "fax_number": "714-870-8405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLDREDGE",
        "first_name": "STEPHANIE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-13",
        "last_updated": "2012-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "CA",
            "license": "PT38600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PT38600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.