Provider Demographics
NPI:1689558389
Name:NEBEKER, TESSA JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:JEAN
Last Name:NEBEKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:JEAN
Other - Last Name:STOOTHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3571 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4843
Mailing Address - Country:US
Mailing Address - Phone:562-290-2472
Mailing Address - Fax:
Practice Address - Street 1:3711 LONG BEACH BLVD STE 805
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3324
Practice Address - Country:US
Practice Address - Phone:310-370-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist