Active NPI
Stacey Rene Ivey, PT
- Physical Therapist
- Sacaton, AZ
National Provider Identifier
1144363128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4392
- Practice address
- 483 W. Seed Farm Rd
Sacaton, AZ 85247 - Phone
- (602) 528-1340
- Fax
- (602) 528-1296
- NPI assigned
- Feb 15, 2007
- Last updated
- Jul 9, 2007
- 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 Therapist | 225100000X | 4392 | AZ | Primary |
Addresses
Primary practice location
483 W. Seed Farm Rd
Sacaton, AZ 85247
Mailing address
Gila River Health Care Corporation
P.O. Box 115
Sacaton, AZ 85247-0115
Phone (602) 528-1340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 824541 | Medicaid | AZ |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4392 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1144363128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "GILA RIVER HEALTH CARE CORPORATION",
"address_2": "P.O. BOX 115",
"city": "SACATON",
"state": "AZ",
"postal_code": "852470115",
"telephone_number": "602-528-1340",
"fax_number": "602-528-1296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 W. SEED FARM RD",
"city": "SACATON",
"state": "AZ",
"postal_code": "85247",
"telephone_number": "602-528-1340",
"fax_number": "602-528-1296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVEY",
"first_name": "STACEY",
"middle_name": "RENE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "4392",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "824541",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacaton, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.