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General NPI Number Information
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NPI Number | 1710101050
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Entity Type | Individual
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Provider Name | TABITHA RAE STUTZMAN PT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9985 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone | 909-427-6995
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Fax |
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Provider Business Mailing Address
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Address Line | 24383 GROVEN LN
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City | MORENO VALLEY
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State | CA
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Zip | 92557-6334
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Country | US
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Telephone | 951-488-1526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27073
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License Number State | CA
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