Individual provider Active NPI

Staci Lynn-Sargent MC Lean, PT

  • Physical Therapist
  • Santa Maria, CA
National Provider Identifier
1023049392
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT21074 Issued in CA
Practice address
2015B S Broadway
Santa Maria, CA 93454-7809
Phone
(805) 440-9318
Fax
(805) 938-5390
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT21074 CA Primary

Addresses

Primary practice location

2015B S Broadway
Santa Maria, CA 93454-7809

Mailing address

1106 Walnut St # 110
San Luis Obispo, CA 93401-2416
Phone (805) 788-0805

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

LicenseStateTypeSpecialty
PT21074CAMDPhysical Therapist
21074CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
San Luis Physical Therapy & Orthopedic Rehabilitation Inc Physical Therapist Past Accepting new patients
CV Physical Therapy, Inc. Physical Therapist Past Accepting new patients
San Luis Physical Therapy & Orthopedic Rehabilitation Inc Physical Therapist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1023049392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 WALNUT ST # 110",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012416",
            "telephone_number": "805-788-0805",
            "fax_number": "805-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015B S BROADWAY",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547809",
            "telephone_number": "805-440-9318",
            "fax_number": "805-938-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MC LEAN",
        "first_name": "STACI",
        "middle_name": "LYNN-SARGENT",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT21074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; 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.