Active NPI
Elyse Claire Stafford, PTA
- Rehabilitation Practitioner
- Newbury Park, CA
National Provider Identifier
1396865366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- AT 936
- Practice address
- 575 Evergreen Ave
Newbury Park, CA 91320-5127 - Phone
- (805) 660-2623
- Fax
- (805) 499-9106
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- 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 Therapy Assistant | 225200000X | AT 936 | CA | |
| Rehabilitation Practitioner | 225400000X | AT 936 | CA | Primary |
Addresses
Primary practice location
575 Evergreen Ave
Newbury Park, CA 91320-5127
Mailing address
575 Evergreen Ave
Newbury Park, CA 91320-5127
Phone (805) 660-2623
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT 936 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1396865366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 EVERGREEN AVE",
"city": "NEWBURY PARK",
"state": "CA",
"postal_code": "913205127",
"telephone_number": "805-660-2623",
"fax_number": "805-499-9106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 EVERGREEN AVE",
"city": "NEWBURY PARK",
"state": "CA",
"postal_code": "913205127",
"telephone_number": "805-660-2623",
"fax_number": "805-499-9106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "ELYSE",
"middle_name": "CLAIRE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT 936",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "AT 936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newbury Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.