Provider Demographics
NPI:1144778960
Name:STADLER, LINDSAY WOFFORD
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:WOFFORD
Last Name:STADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 1/2 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92662-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:485 E 17TH ST
Practice Address - Street 2:ST #650
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3265
Practice Address - Country:US
Practice Address - Phone:949-722-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist