Provider Demographics
NPI:1891546917
Name:STOHLMAN, JARED PHOENIX
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:PHOENIX
Last Name:STOHLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6480
Mailing Address - Country:US
Mailing Address - Phone:916-720-8060
Mailing Address - Fax:
Practice Address - Street 1:404 TOBRURRY WAY
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6337
Practice Address - Country:US
Practice Address - Phone:916-720-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist