Provider Demographics
NPI:1447503339
Name:CORL, STEPHANIE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CORL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KALIVODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2600 STANWELL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4862
Mailing Address - Country:US
Mailing Address - Phone:925-686-5400
Mailing Address - Fax:
Practice Address - Street 1:6759 SIERRA CT STE A
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2657
Practice Address - Country:US
Practice Address - Phone:925-803-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist