Provider Demographics
NPI:1689019705
Name:STAHL, KENNETH LERO (RMT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LERO
Last Name:STAHL
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6835
Mailing Address - Country:US
Mailing Address - Phone:719-231-6429
Mailing Address - Fax:
Practice Address - Street 1:115 N TEJON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1405
Practice Address - Country:US
Practice Address - Phone:719-231-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6517172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist