Provider Demographics
NPI:1164578571
Name:STAHL, ANDREW JAY (LAC LMP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAY
Last Name:STAHL
Suffix:
Gender:M
Credentials:LAC LMP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2726
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070
Mailing Address - Country:US
Mailing Address - Phone:206-463-2945
Mailing Address - Fax:206-463-4714
Practice Address - Street 1:18017 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070
Practice Address - Country:US
Practice Address - Phone:206-463-2945
Practice Address - Fax:206-463-4714
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC458171100000X
WAMA8686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist