Healthcare Provider Details

I. General information

NPI: 1760194302
Provider Name (Legal Business Name): KEVIN STAHL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1392 E PALOMAR ST STE 503
CHULA VISTA CA
91913-1895
US

IV. Provider business mailing address

1884 AQUAMARINE CT UNIT 6
CHULA VISTA CA
91913-8336
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-3000
  • Fax:
Mailing address:
  • Phone: 858-602-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7355
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: