Provider Demographics
NPI:1609994292
Name:STAHL, KIMBERLY LYNNE (NATIONALLY CERTIFIED)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:STAHL
Suffix:
Gender:F
Credentials:NATIONALLY CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 FAIRFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:717-642-5903
Mailing Address - Fax:
Practice Address - Street 1:3144 FAIRFIELD ROAD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-642-5903
Practice Address - Fax:717-642-5903
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist