Active NPI
Bryan Todd Stephenson, MSPT
- Physical Therapist
- Alpine, CA
National Provider Identifier
1932293024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT26642
- Practice address
- 1620 Alpine Blvd
Suite 211
Alpine, CA 91901-1102 - Phone
- (619) 445-3168
- Fax
- (619) 445-5368
- NPI assigned
- Oct 3, 2006
- Last updated
- Oct 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT26642 | CA | Primary |
Addresses
Primary practice location
1620 Alpine Blvd
Suite 211
Alpine, CA 91901-1102
Mailing address
10525 Hollingsworth Way
San Diego, CA 92127
Phone (858) 693-7993
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT0266420 | Medicaid | CA | |
| 0PT266420 | Other | CA | BLUE SHIELD COMMERCIAL |
| 0PT266420 | Other | CA | BLUE SHIELD GOVERNMENT |
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
| License | State | Type | Specialty |
|---|---|---|---|
| PT26642 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alpine Physical Therapy & Wellness Center, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- Alpine, CA
- NPI 1669576930
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223942400000",
"number": "1932293024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10525 HOLLINGSWORTH WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92127",
"telephone_number": "858-693-7993",
"fax_number": "619-445-5368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 ALPINE BLVD",
"address_2": "SUITE 211",
"city": "ALPINE",
"state": "CA",
"postal_code": "919011102",
"telephone_number": "619-445-3168",
"fax_number": "619-445-5368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENSON",
"first_name": "BRYAN",
"middle_name": "TODD",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2008-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT26642",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PT0266420",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD COMMERCIAL",
"identifier": "0PT266420",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD GOVERNMENT",
"identifier": "0PT266420",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alpine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.