Provider Demographics
NPI:1255385746
Name:STUTELBERG, KARL S (MSPT)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:S
Last Name:STUTELBERG
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1916
Mailing Address - Country:US
Mailing Address - Phone:661-471-4080
Mailing Address - Fax:661-524-2964
Practice Address - Street 1:335 E AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1916
Practice Address - Country:US
Practice Address - Phone:661-471-4080
Practice Address - Fax:661-524-2964
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33857225100000X
NV1802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33857AOtherMEDICARE PTAN
NV100506547Medicaid