Active NPI
Stacie Michelle Conn, PTA
- Physical Therapy Assistant
- Amarillo, TX
National Provider Identifier
1023229291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2043057
- Practice address
- 1901 Medi Park Dr
Suite 65
Amarillo, TX 79106-2110 - Phone
- (806) 468-7611
- Fax
- (806) 468-7603
- NPI assigned
- May 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 2043057 | TX | Primary |
Addresses
Primary practice location
1901 Medi Park Dr
Suite 65
Amarillo, TX 79106-2110
Mailing address
5900 Hampton Dr
Amarillo, TX 79109-7145
Phone (806) 355-2923
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2043057 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023229291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5900 HAMPTON DR",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791097145",
"telephone_number": "806-355-2923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 MEDI PARK DR",
"address_2": "SUITE 65",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791062110",
"telephone_number": "806-468-7611",
"fax_number": "806-468-7603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONN",
"first_name": "STACIE",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2043057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.