Marisa D Stack, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39316 Issued in CA

Practice address

140 Wikiup Dr
Santa Rosa, CA 95403-7756

Phone

(707) 542-5400

NPI assigned

Jul 29, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Marisa D Arellano Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1437703345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 MIDWAY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054930",
            "telephone_number": "415-583-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 WIKIUP DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037756",
            "telephone_number": "707-542-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "MARISA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-29",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "ARELLANO",
            "middle_name": "D",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alicia St.John
• Denny Jeb Piolo Sta Ana
• Jewel Sta Maria
• Stac Physical Therapy Sonoma, Inc. (North Santa Rosa Physical Therapy)
• Stacey Stevens, MFT
• Tanya Stadelmaier
• James M Stafford
• Laura M Stafford
• Lisa Laraine Stafford, NP
• Patricia K Stagg, M.D.

• Physical Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.

Verify at the official NPI Registry.