Provider Demographics
NPI:1720275225
Name:FRADERA, STEPHEN EDDIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDDIE
Last Name:FRADERA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 LA MESA TER
Mailing Address - Street 2:#B
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-1704
Mailing Address - Country:US
Mailing Address - Phone:408-515-8866
Mailing Address - Fax:
Practice Address - Street 1:935 LA MESA TER
Practice Address - Street 2:#B
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-1704
Practice Address - Country:US
Practice Address - Phone:408-515-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist