Thomas David Stackpoole, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501010246 Issued in MI

Practice address

6525 2ND Ave
Detroit, MI 48202-3006

Phone

(313) 972-4140

Fax

(313) 972-4134

NPI assigned

Jan 9, 2019

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1265905566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006",
            "telephone_number": "313-972-4166",
            "fax_number": "313-972-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006",
            "telephone_number": "313-972-4140",
            "fax_number": "313-972-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKPOOLE",
        "first_name": "THOMAS",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-09",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARA",
            "identifier": "5501010246",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tstackpoole16099@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "6525 2nd Ave",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482023006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• St. Vincent de Paul Detroit Dental
• John Charles Stabb, PAC
• Brad A Stach, PH.D.
• Elizabeth Stacheit, PA-C
• Margaret Dana Stachurski, D.O.
• Herman Stacy
• Joshua Michael Stadler, RN
• Diane Stafford
• Kerri M Stafford, CRNA
• Kimberly J Stafford, LPC

• Physical Therapist in Detroit, MI
• Providers in Detroit, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.