Provider Demographics
NPI:1306878053
Name:STAHL, JENNIFER L (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STAHL
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 1:2124 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6200
Mailing Address - Country:US
Mailing Address - Phone:760-901-5047
Mailing Address - Fax:760-433-9221
Practice Address - Street 1:2124 S EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6200
Practice Address - Country:US
Practice Address - Phone:760-901-5047
Practice Address - Fax:760-433-9221
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA34588225100000X
OH4297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist