Provider Demographics
NPI:1326111220
Name:STAHL, ANDREW J (MS PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:STAHL
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:UNIT A
Mailing Address - Street 2:140 EAST BOARDWALK DRIVE
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3153
Mailing Address - Country:US
Mailing Address - Phone:970-223-8293
Mailing Address - Fax:970-223-8219
Practice Address - Street 1:UNIT A
Practice Address - Street 2:140 EAST BOARDWALK DRIVE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3153
Practice Address - Country:US
Practice Address - Phone:970-223-8293
Practice Address - Fax:970-223-8219
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-05-12
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Provider Licenses
StateLicense IDTaxonomies
CO7091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800603Medicare PIN