Provider Demographics
NPI:1962577056
Name:DE PERALTA, KAREN STOLP (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:STOLP
Last Name:DE PERALTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5132
Mailing Address - Country:US
Mailing Address - Phone:760-753-0703
Mailing Address - Fax:760-753-0272
Practice Address - Street 1:345 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5132
Practice Address - Country:US
Practice Address - Phone:760-753-0703
Practice Address - Fax:760-753-0272
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14267BMedicare ID - Type Unspecified