Kevin Aaron Stadlbauer, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT014547 Issued in GA

Practice address

590 441 Historic Hwy N Ste E
Demorest, GA 30535-4561

Phone

(706) 754-6611

Fax

(706) 754-5834

NPI assigned

Apr 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1326669615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374214915",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 441 HISTORIC HWY N STE E",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "305354561",
            "telephone_number": "706-754-6611",
            "fax_number": "706-754-5834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "348 Big A Rd",
            "address_purpose": "LOCATION",
            "city": "Toccoa",
            "state": "GA",
            "postal_code": "305776003",
            "country_code": "US",
            "telephone_number": "770-207-6390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STADLBAUER",
        "first_name": "KEVIN",
        "middle_name": "AARON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT014547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSING BOARD",
            "identifier": "PT014547",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christa Dawn Smith, NP-C
• Elizabeth Benson Smith, PT, DPT
• Grayson Smith
• Anny Sosebee, NP-C
• James E Spoden, M.D.
• Kaye Herrin Stanley, PT
• Kevin Sullivan
• Shana Alaine Sumner, MS, RD, LD
• Ravin Batuk Talati, M.D
• Kelly Elizabeth Taylor, ANP

• Physical Therapist in Demorest, GA
• Providers in Demorest, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.