Provider Demographics
NPI:1588713457
Name:KUMMER, STEPHAN II (PTA)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:KUMMER
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 MODOC RD UNIT 26
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4546
Mailing Address - Country:US
Mailing Address - Phone:805-569-1268
Mailing Address - Fax:
Practice Address - Street 1:2320 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4231
Practice Address - Country:US
Practice Address - Phone:805-687-8553
Practice Address - Fax:805-687-5325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4636225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant