Individual
KEVIN AARON STADLBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
590 441 HISTORIC HWY N STE E, DEMOREST, GA 30535-4561
(706) 754-6611
(706) 754-5834
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-4915
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT014547
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT014547
PROFESSIONAL LICENSING BOARD
GA
Enumeration date
04/28/2020
Last updated
05/15/2020
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