Stephanie Marie Blough, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT29076 Issued in CA

Practice address

2345 Erringer Rd
Suite 210
Simi Valley, CA 93065-2235

Phone

(805) 577-6269

Fax

(805) 582-0003

NPI assigned

Jul 19, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Stephanie Marie Wilson Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Divine Health Provider Physical Therapy Inc

  dba Simi Physical Therapy Center

  • Physical Therapy Clinic/Center
  • Simi Valley, CA
  • NPI 1386899763
  NPD (past)
• Simi Valley Therapies West, Inc.

  • Clinic/Center
  • Ventura, CA
  • NPI 1841299286

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1316946759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 ERRINGER RD",
            "address_2": "SUITE 210",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652235",
            "telephone_number": "805-577-6269",
            "fax_number": "805-582-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 ERRINGER RD",
            "address_2": "SUITE 210",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930652235",
            "telephone_number": "805-577-6269",
            "fax_number": "805-582-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOUGH",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT29076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "WILSON",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lexi Kay Bieniek
• Bikram J Soni MD Medical Corporation
• Biomotion Physical Therapy
• Amanda Blake, MS, RD
• Kelly Bleckley, M.A., CCC-SLP
• BLS CPR & First Aid Outreach
• Blueray Home Health, Inc.
• Body Mechanix Physical Therapy Inc
• Lloyd E. Boland III, D.C.
• Natalie Anne Bologna, LMFT

• Physical Therapist in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; 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.