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General NPI Number Information
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NPI Number | 1760194302
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Entity Type | Individual
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Provider Name | KEVIN STAHL PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1392 E PALOMAR ST STE 503
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City | CHULA VISTA
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State | CA
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Zip | 91913-1895
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Country | US
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Telephone | 619-482-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1884 AQUAMARINE CT UNIT 6
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City | CHULA VISTA
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State | CA
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Zip | 91913-8336
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Country | US
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Telephone | 858-602-2767
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 303251
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License Number State | CA
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