Individual provider Active NPI

Brian Staron

  • Physical Therapist
  • Burbank, IL
National Provider Identifier
1164696589
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070016265 Issued in IL
Practice address
8223 Mobile Ave
Burbank, IL 60459-1861
Phone
(630) 726-5374
NPI assigned
Apr 16, 2008
Last updated
Aug 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070016265 IL Primary

Addresses

Primary practice location

8223 Mobile Ave
Burbank, IL 60459-1861

Mailing address

8223 Mobile Ave
Burbank, IL 60459-1861
Phone (630) 726-5374

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

LicenseStateTypeSpecialty
070016265ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Three Point Healthcare LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients
Metabolic Reset Weight Loss, S.C. PastSince Mar 1, 2022 Accepting new patients
Beyer Chiropractic Clinic SC Physical Therapist PastSince Apr 23, 2021 Accepting new patients

Locations

2225 W North Ave
Ste I
Melrose Park, IL 60160
Phone (708) 345-8255

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1164696589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8223 MOBILE AVE",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604591861",
            "telephone_number": "630-726-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8223 MOBILE AVE",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604591861",
            "telephone_number": "630-726-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARON",
        "first_name": "BRIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-16",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070016265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.

Verify at the official NPI Registry.