Provider Demographics
NPI:1013013168
Name:STAHL, JENNIFER B (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:STAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 VIA DEL COLLADO
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6238
Mailing Address - Country:US
Mailing Address - Phone:310-378-9177
Mailing Address - Fax:
Practice Address - Street 1:3858 W CARSON ST
Practice Address - Street 2:SUITE 121
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6709
Practice Address - Country:US
Practice Address - Phone:310-543-9333
Practice Address - Fax:310-405-0954
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT25390OtherPHYSICAL THERAPY LIC. #