Jack M Stagge, P.T., O.C.S.,

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00005726 Issued in WA

Practice address

230 Grant Road, Suite B27
East Wenatchee, WA 98802

Phone

(509) 884-1437

Fax

(509) 884-2811

NPI assigned

Mar 16, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469664000000",
    "number": "1275657355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 GRANT RD",
            "address_2": "STE B27",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "988027715",
            "telephone_number": "509-884-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 GRANT ROAD, SUITE B27",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "98802",
            "telephone_number": "509-884-1437",
            "fax_number": "509-884-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAGGE",
        "first_name": "JACK",
        "middle_name": "M",
        "credential": "P.T., O.C.S.,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2016-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7052665",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in East Wenatchee, WA
• Providers in East Wenatchee, WA by specialty
• Physical Therapist in Washington

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