Walter Stephens, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9354 Issued in TN

Practice address

269 S Main St
Jellico, TN 37762-2018

Phone

(423) 494-0638

NPI assigned

Feb 24, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, KY2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maximum Potential Physical Therapy, PLLCGroup PAC ID 7517267529, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Dayspring Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Williamsburg, KY
  • NPI 1538867551

  Corporate Officer

  CMS ownership

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.

• Maximum Potential Physical Therapy, PLLC

  • Physical Therapist
  • Jellico, TN
  • NPI 1124435102

  KY

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1134589823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 S MAIN ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622018",
            "telephone_number": "423-494-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 S MAIN ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622018",
            "telephone_number": "423-494-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "WALTER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "9354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth J Reed, P.A.C.
• Sarah Roberts, PHARMD
• Crystal G Smiddy
• Matthew Christopher Sowards, PHARMD, MBA
• Springs of Life
• Sunbelt Radiology, PLLC
• Cathleen Connie Suto, M.D.
• Emily Terry, PHARMD
• Geogy Thomas, M.D.
• Shonda Lynn Tucker, APRN

• Physical Therapist in Jellico, TN
• Providers in Jellico, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.