MEDICARE: JARED PHOENIX STOHLMAN

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	225700000X	Massage Therapist	95966	CA

General Provider Information

NPI Number	:	1891546917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED PHOENIX STOHLMAN

Provider Business Mailing Address
First Line	:	2795 E BIDWELL ST STE 100
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-6480
Country	:	US
Telephone Number	:	916-720-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 TOBRURRY WAY
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-6337
Country	:	US
Telephone Number	:	916-720-8060
Fax Number	:

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

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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