Active NPI
Stacy Provost, PT
- Physical Therapist
- Westlake, OH
National Provider Identifier
1265640684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01637
- Practice address
- 26520 Center Ridge Rd
Westlake, OH 44145-4033 - Phone
- (440) 871-3030
- Fax
- (440) 899-3009
- NPI assigned
- May 18, 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 | 01637 | OH | Primary |
Addresses
Primary practice location
26520 Center Ridge Rd
Westlake, OH 44145-4033
Mailing address
3935 W 229TH St
Fairview Park, OH 44126-1041
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 |
|---|---|---|---|
| 01637 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265640684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3935 W 229TH ST",
"city": "FAIRVIEW PARK",
"state": "OH",
"postal_code": "441261041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26520 CENTER RIDGE RD",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441454033",
"telephone_number": "440-871-3030",
"fax_number": "440-899-3009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVOST",
"first_name": "STACY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "01637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westlake, OH
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.