Provider Demographics
NPI:1922470830
Name:STOERZBACH, JACLYN DANIELLE
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:DANIELLE
Last Name:STOERZBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10485 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-4101
Mailing Address - Country:US
Mailing Address - Phone:303-469-1190
Mailing Address - Fax:303-469-4130
Practice Address - Street 1:10485 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-4101
Practice Address - Country:US
Practice Address - Phone:303-469-1190
Practice Address - Fax:303-469-4130
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist