MEDICARE: JASON M STODELLE MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT32912	CA

General Provider Information

NPI Number	:	1144244922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M STODELLE MPT

Provider Business Mailing Address
First Line	:	24630 WASHINGTON AVE
Second Line	:	STE 200
City	:	MURRIETA
State	:	CA
Zip	:	92562-6177
Country	:	US
Telephone Number	:	951-696-9353
Fax Number	:	951-973-7216

Provider Business Practice Location Address
First Line	:	73600 ALESSANDRO DR
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3606
Country	:	US
Telephone Number	:	760-674-0675
Fax Number	:	760-674-0645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	12/28/2007

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