Active NPI
Stacy Ellis, PTA
- Physical Therapy Assistant
- Somerset, MA
National Provider Identifier
1043687098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2826
- Practice address
- 455 Brayton Ave
Somerset, MA 02726-2642 - Phone
- (508) 679-2240
- NPI assigned
- Aug 25, 2015
- 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 Therapy Assistant | 225200000X | 2826 | MA | Primary |
Addresses
Primary practice location
455 Brayton Ave
Somerset, MA 02726-2642
Mailing address
PO Box 9242
Fall River, MA 02720-0005
Phone (774) 319-7930
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 |
|---|---|---|---|
| 2826 | MA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440460800000",
"number": "1043687098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9242",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027200005",
"telephone_number": "774-319-7930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 BRAYTON AVE",
"city": "SOMERSET",
"state": "MA",
"postal_code": "027262642",
"telephone_number": "508-679-2240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "STACY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-25",
"last_updated": "2015-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "2826",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerset, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.