Provider Demographics
NPI:1427154475
Name:MONGIELLO, STEPHEN P (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:MONGIELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 CLAY ST
Mailing Address - Street 2:APARTMENT GARDEN
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3774
Mailing Address - Country:US
Mailing Address - Phone:415-796-3011
Mailing Address - Fax:
Practice Address - Street 1:247 SHORELINE HWY
Practice Address - Street 2:SUITE B2
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3664
Practice Address - Country:US
Practice Address - Phone:415-796-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI256164OtherHMSA
HI2745651OtherUHA