Individual provider Active NPI

Joseph Stuthers, MS, ATC, LAT

  • Athletic Trainer
  • Windermere, FL
National Provider Identifier
1417461997
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AL4874 Issued in FL
Practice address
5523 Winter Garden Vineland Rd
Windermere, FL 34786-6097
Phone
(850) 380-7628
NPI assigned
Nov 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 1824 AL
Athletic Trainer 2255A2300X AL4874 FL Primary

Addresses

Primary practice location

5523 Winter Garden Vineland Rd
Windermere, FL 34786-6097

Mailing address

10418 Log House Rd
Clermont, FL 34711-8450
Phone (850) 380-7628

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
AL4874FLMDAthletic Trainer
1824ALMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1417461997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10418 LOG HOUSE RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118450",
            "telephone_number": "850-380-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5523 WINTER GARDEN VINELAND RD",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347866097",
            "telephone_number": "850-380-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUTHERS",
        "first_name": "JOSEPH",
        "credential": "MS, ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "1824",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windermere, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.