Provider Demographics
NPI:1477626364
Name:STAHL, AMY MICHELLE (MSPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:STAHL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
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
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC552958Medicare PIN