Healthcare Provider Details

I. General information

NPI: 1306878053
Provider Name (Legal Business Name): JENNIFER L STAHL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 S EL CAMINO REAL SUITE 100
OCEANSIDE CA
92054-6200
US

IV. Provider business mailing address

2124 S EL CAMINO REAL SUITE 100
OCEANSIDE CA
92054-6200
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5047
  • Fax: 760-433-9221
Mailing address:
  • Phone: 760-901-5047
  • Fax: 760-433-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: