Active NPI
Stephen Gregg Decker, MPT
- Physical Therapist
- Leesport, PA
National Provider Identifier
1306019369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT012314
- Practice address
- 5479 Pottsville Pike
Suite 200
Leesport, PA 19533-8650 - Phone
- (610) 926-6778
- Fax
- (610) 926-7200
- NPI assigned
- Apr 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9675 | NC | |
| Physical Therapist | 225100000X | PT012314 | PA | Primary |
Addresses
Primary practice location
5479 Pottsville Pike
Suite 200
Leesport, PA 19533-8650
Mailing address
1212 Garfield Ave
Suite 200
Parkersburg, WV 26101-3247
Phone (304) 865-6778
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1025419330001 | Medicaid | PA | |
| 149TT | Other | NC | BCBSNC |
| P00975709 | Other | RAILROAD MEDICARE | |
| 7212400 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9675 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333497600000",
"number": "1306019369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 GARFIELD AVE",
"address_2": "SUITE 200",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261013247",
"telephone_number": "304-865-6778",
"fax_number": "304-865-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5479 POTTSVILLE PIKE",
"address_2": "SUITE 200",
"city": "LEESPORT",
"state": "PA",
"postal_code": "195338650",
"telephone_number": "610-926-6778",
"fax_number": "610-926-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECKER",
"first_name": "STEPHEN",
"middle_name": "GREGG",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-10",
"last_updated": "2012-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "9675",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT012314",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1025419330001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC",
"identifier": "149TT",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00975709",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7212400",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesport, PA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.