Stacy A Fredrickson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05010467A Issued in IN

Practice address

10787 Randolph St Ste 220
Winfield, IN 46307-7615

Phone

(219) 333-5900

NPI assigned

Apr 12, 2013

Last updated

Dec 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Stacy A Orris Former name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Physical Therapy, Occupational Therapy and Speech Language PAGroup PAC ID 7012997638, 385 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Peru, IN
  • NPI 1750764494
  Medicare reassignment Care Compare group NPD
• Innovative Physical Therapy LLC

  • Physical Therapist
  • Chesterton, IN
  • NPI 1578937447
  Medicare reassignment NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1285077941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-576-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10787 RANDOLPH ST STE 220",
            "city": "WINFIELD",
            "state": "IN",
            "postal_code": "463077615",
            "telephone_number": "219-333-5900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8259 Wicker Ave",
            "address_purpose": "LOCATION",
            "city": "Saint John",
            "state": "IN",
            "postal_code": "463738878",
            "country_code": "US",
            "telephone_number": "219-365-6560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "748 E Porter Ave",
            "address_purpose": "LOCATION",
            "city": "Chesterton",
            "state": "IN",
            "postal_code": "463049101",
            "country_code": "US",
            "telephone_number": "219-255-1566",
            "fax_number": "219-215-6115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "STACY",
        "middle_name": "A",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05010467A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "ORRIS",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Winfield, IN
• Providers in Winfield, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.