Active NPI
Dane Michael Staples, PT, DPT
- Physical Therapist
- Phoenix, AZ
National Provider Identifier
1396224879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30527
- Practice address
- 17233 N Holmes Blvd Ste 1650
Phoenix, AZ 85053-2031 - Phone
- (602) 547-1836
- NPI assigned
- Aug 7, 2018
- 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 | 5501018808 | MI | |
| Physical Therapist | 225100000X | 30527 | AZ | Primary |
Addresses
Primary practice location
17233 N Holmes Blvd Ste 1650
Phoenix, AZ 85053-2031
Mailing address
17233 N Holmes Blvd Ste 1650
Phoenix, AZ 85053-2031
Phone (602) 547-1836
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30527 | Other | AZ | LICENSE |
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 |
|---|---|---|---|
| 5501018808 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Strength Training Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Customized Equipment (DME)
- Phoenix, AZ
- NPI 1356552996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550707200000",
"number": "1396224879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17233 N HOLMES BLVD STE 1650",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850532031",
"telephone_number": "602-547-1836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17233 N HOLMES BLVD STE 1650",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850532031",
"telephone_number": "602-547-1836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAPLES",
"first_name": "DANE",
"middle_name": "MICHAEL",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2019-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501018808",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "30527",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "30527",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.