Active NPI
Stephen S Potisuk, PT
- Physical Therapist
- St Charles, IL
National Provider Identifier
1033412002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.011469
- Practice address
- 44W121 Empire Rd
St Charles, IL 60175-8256 - Phone
- (630) 337-9545
- NPI assigned
- Dec 14, 2010
- Sex
- Male
- 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 Therapist | 225100000X | 070.011469 | IL | Primary |
Addresses
Primary practice location
44W121 Empire Rd
St Charles, IL 60175-8256
Mailing address
44W121 Empire Rd
St Charles, IL 60175-8256
Phone (630) 337-9545
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 |
|---|---|---|---|
| 070.011469 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292284800000",
"number": "1033412002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44W121 EMPIRE RD",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601758256",
"telephone_number": "630-337-9545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44W121 EMPIRE RD",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601758256",
"telephone_number": "630-337-9545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTISUK",
"first_name": "STEPHEN",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-14",
"last_updated": "2010-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.011469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.