Viki W Storm, P.T. – Physical Therapist in Conway, MA

Key facts

NPI: 1295722130
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 2193 (MA)
Practice address: 134 River St.
Conway, MA 01341-0147
Phone: (413) 369-4348
Fax: (413) 369-0282
NPI assigned: Oct 5, 2005
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
2193	MA	MD	Physical Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	2193	MA	Yes

Addresses

Primary practice location

134 River St.
Conway, MA 01341-0147

Mailing address

134 River St.
PO Box 147
Conway, MA 01341-0147
Phone (413) 369-4348

Other identifiers

Identifier	Type	State	Issuer
P00187267	Other	MA	RAILROAD MEDICARE
0332844	Medicaid	MA
Y65462	Other	MA	BLUE CROSS BLUE SHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 22, 2010.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1295722130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 RIVER ST.",
            "address_2": "PO BOX 147",
            "city": "CONWAY",
            "state": "MA",
            "postal_code": "013410147",
            "telephone_number": "413-369-4348",
            "fax_number": "413-369-0282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 RIVER ST.",
            "city": "CONWAY",
            "state": "MA",
            "postal_code": "013410147",
            "telephone_number": "413-369-4348",
            "fax_number": "413-369-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORM",
        "first_name": "VIKI",
        "middle_name": "W",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-05",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "2193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00187267",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0332844",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y65462",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, MA

All providers in Conway, MA · Physical Therapist in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.