NPIMap

Individual provider Active NPI

Staci Gaye Ellis, MSPT

  • Physical Therapist
  • Lakewood, WA
National Provider Identifier
1376543884
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT7361 Issued in WA
Practice address
7308 Bridgeport Way W Ste 103
Lakewood, WA 98499-8000
Phone
(253) 582-8500
Fax
(253) 582-8160
NPI assigned
Jul 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT7361 WA Primary

Addresses

Primary practice location

7308 Bridgeport Way W Ste 103
Lakewood, WA 98499-8000

Mailing address

3209 S 23Rd St
Tacoma, WA 98405-1602
Phone (253) 459-6999

Other practice location 1

4905 108th St SW
Lakewood, WA 98499-3724
Phone (253) 589-0611

Other identifiers 1

IdentifierTypeStateIssuer
00007361OtherWAPT LICENSE

Other names 1

  • Staci Gaye Guffey Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091102000378 WA Practitioner - Physical Therapist in Private Practice 9537206073 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT7361WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Physical Therapist CurrentSince Dec 1, 2014 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Dec 1, 2014 Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince Jan 3, 2022 Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince Jan 3, 2022 Accepting new patients
Adult Rehabilitation Therapies, PLLC Physical Therapist Past Accepting new patients
Multicare Health System Physical Therapist Past Accepting new patients

Locations

10207 19th Ave SE
Everett, WA 98208
Phone (425) 337-3166

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

403 W Stanley St
Granite Falls, WA 98252
Phone (360) 691-4835

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

4220 132nd St SE
Ste 101
Mill Creek, WA 98012
Phone (425) 316-8046

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1376543884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 S 23RD ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051602",
            "telephone_number": "253-459-6999",
            "fax_number": "253-459-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7308 BRIDGEPORT WAY W STE 103",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984998000",
            "telephone_number": "253-582-8500",
            "fax_number": "253-582-8160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4905 108th St SW",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WA",
            "postal_code": "984993724",
            "country_code": "US",
            "telephone_number": "253-589-0611",
            "fax_number": "253-588-2277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "STACI",
        "middle_name": "GAYE",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT7361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "00007361",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "GUFFEY",
            "middle_name": "GAYE",
            "credential": "MSPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.