NPIMap

Organization Active NPI

Stac Physical Therapy Emeryville, Inc.

Doing business as Emeryville Sports Physical Therapy

  • Orthopedic Physical Therapist
  • Emeryville, CA
National Provider Identifier
1326527730
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
33997 Issued in CA
Legal business name
STAC PHYSICAL THERAPY EMERYVILLE, INC.
Doing business as
Emeryville Sports Physical Therapy
Practice address
2322 Powell St
Emeryville, CA 94608-1738
Phone
(626) 825-3739
NPI assigned
Aug 8, 2018
Last updated
Jul 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Or Nativ, PT, CSCSNPI 1588205587
Title
Clinical Director
Phone
(510) 653-5151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 33997 CA Primary

Addresses

Primary practice location

2322 Powell St
Emeryville, CA 94608-1738

Mailing address

2322 Powell St
Emeryville, CA 94608-1738

Other names 1

  • Emeryville Sports Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180912002586 CA Part B Supplier - Clinic/Group Practice 3971853938 Receives reassigned benefits from 13 practitioners
Practice locations: Emeryville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1326527730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2322 POWELL ST",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 POWELL ST",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081738",
            "telephone_number": "626-825-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAC PHYSICAL THERAPY EMERYVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-08",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "NATIV",
        "authorized_official_first_name": "OR",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "510-653-5151",
        "authorized_official_credential": "PT, CSCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "33997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emeryville Sports Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emeryville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.