Jeremy Robert Stuck, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

002281 Issued in WV

Practice address

54 W 3Rd Ave
Williamson, WV 25661-3508

Phone

(304) 235-4300

Fax

(304) 235-0176

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Physcial and Aquatic Therapy, Inc.

  • Physical Therapist
  • Williamson, WV
  • NPI 1578671681
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053334557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 RUSS ST",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "154018934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 W 3RD AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613508",
            "telephone_number": "304-235-4300",
            "fax_number": "304-235-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCK",
        "first_name": "JEREMY",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT015972",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "002281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000550",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "571136141003",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven C. Wilson, O.D. Inc.
• Patricia Stone
• Timothy Harold Stone
• Marlena Stratton
• Dana Kay Strom
• Tyler Austin Stump
• Brenda Sturgell
• Manolo D Tampoya, MD
• Megan Nichole Taylor, DDS
• Sharon G Taylor

• Physical Therapist in Williamson, WV
• Providers in Williamson, WV by specialty
• Physical Therapist in West Virginia

• 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.

Verify at the official NPI Registry.