Stacey Gill, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA9249 Issued in FL

Practice address

916 N Dixie Fwy
New Smyrna Beach, FL 32168-6220

Phone

(386) 426-7885

NPI assigned

Apr 11, 2016

Last updated

Apr 11, 2016By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Blue Water Therapy Inc

  • Clinic/Center
  • New Smyrna Beach, FL
  • NPI 1538409966
  NPD (past)

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1205290780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2447 OLD SAMSULA RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 N DIXIE FWY",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686220",
            "telephone_number": "386-426-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILL",
        "first_name": "STACEY",
        "name_prefix": "Mr.",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA9249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie A Gennaro, LMT
• Shelley Ann George, APRN
• Ilana Rachel Gerber, BCBA
• Tara Gibson
• Brian Gil, PTA
• Matthew Thomas Gilmour, LCSW
• Gingras Wellness Center LLC
• Josephine Goeb
• Samuel Alejandro Gonzalez Goyri, MD
• Mark Gonzalez, HIS

• Physical Therapy Assistant in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.