Kenneth P Stack, PT,MS,CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8899 Issued in NC

Practice address

115 S Saint Marys St
Suite a
Raleigh, NC 27603-1785

Phone

(800) 362-0903

Fax

(866) 434-5096

NPI assigned

Oct 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Raleigh Foot Center,PA

  • Foot & Ankle Surgery Podiatrist
  • Raleigh, NC
  • NPI 1619915501
  NPD (past)
• Syracuse Orthopedic Specialists, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Liverpool, NY
  • NPI 1689953135
  NPD (past)

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269648000000",
    "number": "1346230489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 EVA MAE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276104443",
            "telephone_number": "800-362-0903",
            "fax_number": "866-434-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S SAINT MARYS ST",
            "address_2": "SUITE A",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276031785",
            "telephone_number": "800-362-0903",
            "fax_number": "866-434-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "KENNETH",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PT,MS,CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2010-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "8899",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NC",
            "license": "8899",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NC",
            "license": "8899",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NC",
            "license": "8899",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11337022",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212592",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "078V4",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle M St. Jean, CRNA
• Tanya St. Julien, LPC
• Katie Lyn St. Pierre, PMHNP-BC, FNP-BC
• St' Ephraims Home Healthcare Services LLC
• Erin Stack, LPTA
• Annis Stacy
• Justin Stacy, DMD
• Ryan K Staehling, D.D.S.
• Stephen J Stafford, MD
• Sydney Stafford, RN

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.