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General NPI Number Information
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NPI Number | 1891546917
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Entity Type | Individual
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Provider Name | JARED PHOENIX STOHLMAN
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Gender | Male
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 404 TOBRURRY WAY
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City | FOLSOM
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State | CA
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Zip | 95630-6337
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Country | US
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Telephone | 916-720-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 2795 E BIDWELL ST STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-6480
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Country | US
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Telephone | 916-720-8060
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 95966
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License Number State | CA
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