Provider Demographics
NPI:1962528489
Name:SOUZA, STEPHEN AUGUST (RPT DPT)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AUGUST
Last Name:SOUZA
Suffix:
Gender:M
Credentials:RPT DPT
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:A
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT INC
Mailing Address - Street 1:23105 LA GRAN JA DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2320
Mailing Address - Country:US
Mailing Address - Phone:661-297-6217
Mailing Address - Fax:818-365-1259
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 335
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-9690
Practice Address - Fax:818-365-9199
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT12097Medicare ID - Type Unspecified