Provider Demographics
NPI:1447134754
Name:STOUDT, JACQUELINE CORY
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CORY
Last Name:STOUDT
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 1:619 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RED HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18076-1376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5504
Practice Address - Country:US
Practice Address - Phone:484-658-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE0138022081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine