Stacy A Fredrickson, PT, DPT
Individual provider Active NPI Physical Therapist · Winfield, IN
NPI 1285077941 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1285077941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05010467A (IN)
- Practice address
- 10787 Randolph St Ste 220
Winfield, IN 46307-7615 - Phone
- (219) 333-5900
- NPI assigned
- Apr 12, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- 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 PA
Practice addresses (Care Compare)
10787 Randolph St
Suite 220
Winfield, IN 46307-7615
Phone (219) 333-5900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200103001934 | IN | Practitioner - Physical Therapist in Private Practice | 7113351826 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path | Physical Therapist | Current |
Accepting new patients |
| Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC | Current |
Accepting new patients | |
| Innovative Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
Locations
502 E 1100 N
Chesterton, IN 46304
Phone (219) 926-5850
11275 Delaware Pkwy
#B
Crown Point, IN 46307
Phone (219) 304-6074
60 W 94th Pl
Crown Point, IN 46307
Phone (219) 661-9508
5 Broadway Plz
Peru, IN 46970
Phone (765) 327-2111
265 Morthland Dr
Ste A
Valparaiso, IN 46383
Phone 2199265850 ext. 2
10787 Randolph St
Ste 220
Winfield, IN 46307
Phone (219) 333-5900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05010467A | IN | Yes |
Addresses
Primary practice location
10787 Randolph St Ste 220
Winfield, IN 46307-7615
Mailing address
625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 576-6200
Other practice location 1
8259 Wicker Ave
Saint John, IN 46373-8878
Phone (219) 365-6560
Other practice location 2
748 E Porter Ave
Chesterton, IN 46304-9101
Phone (219) 255-1566
Other names
- Stacy A Orris
Other providers in Winfield, IN
- Agusti Medical Corporation
- Jose Luis Agusti
- Apc Holdings LLC
- Sarah Camel
- Nicole Gilbert
- Janelle Golly
- Rebecca J Groen
- Van Huffine I
- Joshua Patrick James
All providers in Winfield, IN · Physical Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.