Provider Demographics
NPI:1275001588
Name:CHRISTL, STEPHANIE JO (CMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:CHRISTL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8537 ROLLING GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6247
Mailing Address - Country:US
Mailing Address - Phone:916-832-5555
Mailing Address - Fax:
Practice Address - Street 1:706 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3074
Practice Address - Country:US
Practice Address - Phone:916-832-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist