Active NPI
Derek Storts
- Physical Therapy Assistant
- Lake Placid, FL
National Provider Identifier
1164086443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA28259
- Practice address
- 1297 US Highway 27 N
Lake Placid, FL 33852-7907 - Phone
- (866) 888-2002
- NPI assigned
- Apr 23, 2019
- 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 Therapy Assistant | 225200000X | PTA28259 | FL | Primary |
Addresses
Primary practice location
1297 US Highway 27 N
Lake Placid, FL 33852-7907
Mailing address
3037 Edwards Peace Dr
Wauchula, FL 33873-8419
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 |
|---|---|---|---|
| PTA28259 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555977600000",
"number": "1164086443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3037 EDWARDS PEACE DR",
"city": "WAUCHULA",
"state": "FL",
"postal_code": "338738419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1297 US HIGHWAY 27 N",
"city": "LAKE PLACID",
"state": "FL",
"postal_code": "338527907",
"telephone_number": "866-888-2002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STORTS",
"first_name": "DEREK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-23",
"last_updated": "2019-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA28259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Placid, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.