Active NPI
Staci Cathy-Sue Roberts, PTA
- Physical Therapy Assistant
- Port Orange, FL
National Provider Identifier
1205057858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA20841
- Practice address
- 1525 Herbert St
Port Orange, FL 32129 - Phone
- (386) 756-0424
- NPI assigned
- May 1, 2007
- Sex
- Female
- 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 | PTA20841 | FL | Primary |
Addresses
Primary practice location
1525 Herbert St
Port Orange, FL 32129
Mailing address
11300 NW 90 Ave
Reddick, FL 32686
Phone (352) 622-2570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA20841 | Other | FL | LICENSURE |
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 |
|---|---|---|---|
| PTA20841 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205057858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11300 NW 90 AVE",
"city": "REDDICK",
"state": "FL",
"postal_code": "32686",
"telephone_number": "352-622-2570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 HERBERT ST",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "32129",
"telephone_number": "386-756-0424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "STACI",
"middle_name": "CATHY-SUE",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA20841",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSURE",
"identifier": "PTA20841",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- 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.