Active NPI
Stacey Ann Henderson, MSPT
- Physical Therapist
- Pennsauken, NJ
National Provider Identifier
1013059864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT011562L
- Practice address
- 5105 N Park Dr
Pennsauken, NJ 08109-4630 - Phone
- (856) 665-9111
- NPI assigned
- Feb 12, 2007
- Last updated
- May 27, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT011562L | PA | Primary |
Addresses
Primary practice location
5105 N Park Dr
Pennsauken, NJ 08109-4630
Mailing address
434 Yale Ave
Cherry Hill, NJ 08002-2269
Phone (856) 663-2840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT011562L | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ultima Rehab-NJ LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Geriatric Physical Therapist
- Wall Township, NJ
- NPI 1427426485
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306454400000",
"number": "1013059864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 YALE AVE",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080022269",
"telephone_number": "856-663-2840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5105 N PARK DR",
"city": "PENNSAUKEN",
"state": "NJ",
"postal_code": "081094630",
"telephone_number": "856-665-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "STACEY",
"middle_name": "ANN",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2011-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT011562L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pennsauken, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.